Provider Demographics
NPI:1306965918
Name:ARCHER, KRISTINE (MS-CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:BATTENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-CCC-SLP
Mailing Address - Street 1:3 DEVON CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 MILKSHAKE LN
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1507
Practice Address - Country:US
Practice Address - Phone:410-269-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist