Provider Demographics
NPI:1316689763
Name:GAVINELLI, KRISTEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GAVINELLI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530
Practice Address - Country:US
Practice Address - Phone:908-907-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14263948235Z00000X
NJ41YS00899500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist