Provider Demographics
NPI:1699311928
Name:MIDDLEBROOKS, KRISTEN MARKHAM
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARKHAM
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HARMONY CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-1661
Mailing Address - Country:US
Mailing Address - Phone:864-918-6041
Mailing Address - Fax:
Practice Address - Street 1:23 HARMONY CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-1661
Practice Address - Country:US
Practice Address - Phone:864-918-6041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist