Provider Demographics
NPI:1215455134
Name:WEINGART, KRISTIN M (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:WEINGART
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:GRODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 HIGHWAY 17 BYP S
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4500
Mailing Address - Country:US
Mailing Address - Phone:843-318-9207
Mailing Address - Fax:
Practice Address - Street 1:5000 HIGHWAY 17 BYP S
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4500
Practice Address - Country:US
Practice Address - Phone:843-318-9207
Practice Address - Fax:843-582-0259
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6884235Z00000X
IL242004489235Z00000X
14174741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA2198Medicaid