Provider Demographics
NPI:1588936462
Name:LENGACHER, KRISTA JO (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:JO
Last Name:LENGACHER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 PECAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3414
Mailing Address - Country:US
Mailing Address - Phone:704-654-8116
Mailing Address - Fax:
Practice Address - Street 1:1432 PECAN AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3414
Practice Address - Country:US
Practice Address - Phone:704-654-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist