Provider Demographics
NPI:1386750628
Name:ELSTON, KRISTA K (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:K
Last Name:ELSTON
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3786 CARWINION WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8319
Mailing Address - Country:US
Mailing Address - Phone:317-875-3927
Mailing Address - Fax:317-329-1001
Practice Address - Street 1:7112 ZIONSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2163
Practice Address - Country:US
Practice Address - Phone:317-329-1000
Practice Address - Fax:317-329-1001
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003311A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000365570OtherANTHEM INSURANCE