Provider Demographics
NPI:1962806539
Name:KNIGHT-CRADDOCK, KRISTI KIRBY
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:KIRBY
Last Name:KNIGHT-CRADDOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTI
Other - Middle Name:KIRBY
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1310 N FOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1423
Mailing Address - Country:US
Mailing Address - Phone:937-207-8456
Mailing Address - Fax:
Practice Address - Street 1:25 WEST HIGH STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45501
Practice Address - Country:US
Practice Address - Phone:937-325-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP4812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist