Provider Demographics
NPI:1326645722
Name:DATTORIA, KRISTIN YOSHIKO (SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:YOSHIKO
Last Name:DATTORIA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:YOSHIKO
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2741 LOCH HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-8815
Mailing Address - Country:US
Mailing Address - Phone:661-618-0861
Mailing Address - Fax:
Practice Address - Street 1:20130 LAKEVIEW CENTER PLZ STE 400
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5905
Practice Address - Country:US
Practice Address - Phone:847-751-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist