Provider Demographics
NPI:1285794172
Name:CULBERTSON, KRISTAN ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTAN
Middle Name:ELIZABETH
Last Name:CULBERTSON
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 1:1881 W SHELLIE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2508
Mailing Address - Country:US
Mailing Address - Phone:928-550-0056
Mailing Address - Fax:
Practice Address - Street 1:1881 W SHELLIE DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2508
Practice Address - Country:US
Practice Address - Phone:928-550-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP1488OtherDEPT. HEALTH SERVICES LIC
AZ594748OtherACCHS