Provider Demographics
NPI:1417751371
Name:GREEN, KRISTEN FRANCES (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:FRANCES
Last Name:GREEN
Suffix:
Gender:
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 1:1973 PENFOLD WAY
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8710
Mailing Address - Country:US
Mailing Address - Phone:603-897-9285
Mailing Address - Fax:
Practice Address - Street 1:20 LADYSLIPPER LN
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1372
Practice Address - Country:US
Practice Address - Phone:843-689-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034653235Z00000X
CO0006338235Z00000X
SC9173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist