Provider Demographics
NPI:1427294305
Name:DELGADO, KRISTINE LEIGH (SLP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LEIGH
Last Name:DELGADO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 IVY WAY
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1729
Mailing Address - Country:US
Mailing Address - Phone:347-452-4317
Mailing Address - Fax:
Practice Address - Street 1:140 MEISNER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1236
Practice Address - Country:US
Practice Address - Phone:347-452-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017302-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist