Provider Demographics
NPI:1285451492
Name:COUSINEAU, KRISTY (SLPA)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:COUSINEAU
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 NE LAURA AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6141
Mailing Address - Country:US
Mailing Address - Phone:503-984-4017
Mailing Address - Fax:
Practice Address - Street 1:1204 NE 201ST AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-2499
Practice Address - Country:US
Practice Address - Phone:503-661-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist