Provider Demographics
NPI:1316127509
Name:THAYER, KRISTEN D (MS, SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:D
Last Name:THAYER
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 RUTLEDGE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5855
Mailing Address - Country:US
Mailing Address - Phone:843-876-7200
Mailing Address - Fax:843-727-6400
Practice Address - Street 1:208 RUTLEDGE AVE APT B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5855
Practice Address - Country:US
Practice Address - Phone:843-876-7200
Practice Address - Fax:843-727-6400
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist