Provider Demographics
NPI:1215175674
Name:HEAD, KRISI KIM (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KRISI
Middle Name:KIM
Last Name:HEAD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5327 31ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3517
Mailing Address - Country:US
Mailing Address - Phone:806-470-2071
Mailing Address - Fax:
Practice Address - Street 1:1301 MESA DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-3905
Practice Address - Country:US
Practice Address - Phone:806-296-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102995235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist