Provider Demographics
NPI:1972767853
Name:NAILOR, KRISTINE ELISABETH
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ELISABETH
Last Name:NAILOR
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 1:425 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2983
Mailing Address - Country:US
Mailing Address - Phone:518-761-2025
Mailing Address - Fax:
Practice Address - Street 1:425 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2983
Practice Address - Country:US
Practice Address - Phone:518-761-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0163461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11864562OtherCAQH