Provider Demographics
NPI:1124244116
Name:DRUM, KRISTINE ANNE (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANNE
Last Name:DRUM
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 POLO RD STE 109
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4860
Mailing Address - Country:US
Mailing Address - Phone:336-407-6257
Mailing Address - Fax:
Practice Address - Street 1:3455 POLO RD STE 109
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4860
Practice Address - Country:US
Practice Address - Phone:336-407-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412387Medicaid