Provider Demographics
NPI:1215237318
Name:DIRLAM, KRISTY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:DIRLAM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 GREEN TREE DR
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568-9308
Mailing Address - Country:US
Mailing Address - Phone:315-986-8728
Mailing Address - Fax:
Practice Address - Street 1:6264 ROUTE 88
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9772
Practice Address - Country:US
Practice Address - Phone:315-483-5282
Practice Address - Fax:315-483-5292
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013534-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist