Provider Demographics
NPI:1386603645
Name:STOWERS, KRISTINA DAWN (MA/CCC-S)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:DAWN
Last Name:STOWERS
Suffix:
Gender:
Credentials:MA/CCC-S
Other - Prefix:MRS
Other - First Name:KRISTINA
Other - Middle Name:DAWN
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/CCC-S
Mailing Address - Street 1:495 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:LAVALETTE
Mailing Address - State:WV
Mailing Address - Zip Code:25535-8753
Mailing Address - Country:US
Mailing Address - Phone:304-395-0167
Mailing Address - Fax:
Practice Address - Street 1:1402 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1611
Practice Address - Country:US
Practice Address - Phone:304-395-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
WVSLP-0839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV740511200Medicaid