Provider Demographics
NPI:1326885054
Name:MORAN, KRISTINA DANIELLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:DANIELLE
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OLD PASTURE RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3151
Mailing Address - Country:US
Mailing Address - Phone:978-273-0568
Mailing Address - Fax:
Practice Address - Street 1:23 OLD PASTURE RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-3151
Practice Address - Country:US
Practice Address - Phone:978-273-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist