Provider Demographics
NPI:1902994890
Name:REDMOND, KRISTI ELAINE (MSP, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ELAINE
Last Name:REDMOND
Suffix:
Gender:F
Credentials:MSP, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 WEATHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8694
Mailing Address - Country:US
Mailing Address - Phone:803-640-6342
Mailing Address - Fax:
Practice Address - Street 1:595 WEATHERWOOD CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8694
Practice Address - Country:US
Practice Address - Phone:803-640-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3009235Z00000X
NC3664235Z00000X
GASLP003569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0687Medicaid