Provider Demographics
NPI:1306351655
Name:WHITE, KRISTIN ELISE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5323
Mailing Address - Country:US
Mailing Address - Phone:618-997-6063
Mailing Address - Fax:
Practice Address - Street 1:400 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5323
Practice Address - Country:US
Practice Address - Phone:618-997-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist