Provider Demographics
NPI:1275842163
Name:FREELAND, KRISTIN JOY (SPEECH LANGUAGE PATH)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:JOY
Last Name:FREELAND
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3610
Mailing Address - Country:US
Mailing Address - Phone:419-651-6368
Mailing Address - Fax:850-279-3298
Practice Address - Street 1:141 C. SOUTH JOHN SIMS PKWY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:FL
Practice Address - Zip Code:32580-2711
Practice Address - Country:US
Practice Address - Phone:194-651-6368
Practice Address - Fax:850-279-3298
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8621235Z00000X
FLSA12063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8621OtherSPEECH LANGUAGE PATHOLOGIST
FL009331400Medicaid