Provider Demographics
NPI:1851642649
Name:VAVOULES, KRISTIN ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ANN
Last Name:VAVOULES
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 1:3547 34TH ST
Mailing Address - Street 2:APT. 4C
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1969
Mailing Address - Country:US
Mailing Address - Phone:631-741-7224
Mailing Address - Fax:
Practice Address - Street 1:3547 34TH ST
Practice Address - Street 2:APT. 4C
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1969
Practice Address - Country:US
Practice Address - Phone:631-741-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist