Provider Demographics
NPI:1992060842
Name:SCHULTZ, KRISTIN KARIN (MA-CCC,SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KARIN
Last Name:SCHULTZ
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 1:32404 OUTRIGGER WAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4222
Mailing Address - Country:US
Mailing Address - Phone:714-349-7187
Mailing Address - Fax:
Practice Address - Street 1:32404 OUTRIGGER WAY
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4222
Practice Address - Country:US
Practice Address - Phone:714-349-7187
Practice Address - Fax:949-218-7580
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist