Provider Demographics
NPI:1699502872
Name:CRIST, KAYLA JANE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JANE
Last Name:CRIST
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 1:188 MIDDLESEX RD # A
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1563
Mailing Address - Country:US
Mailing Address - Phone:217-919-7764
Mailing Address - Fax:
Practice Address - Street 1:42 BARROWS DR
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1326
Practice Address - Country:US
Practice Address - Phone:207-725-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST4117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist