Provider Demographics
NPI:1992075345
Name:YAGER, KRISTOPHER GEORGE (MS-ED, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:GEORGE
Last Name:YAGER
Suffix:
Gender:M
Credentials:MS-ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 BALLTOWN RD
Mailing Address - Street 2:C/O STUDENT SUPPORT SERVICES
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2304
Mailing Address - Country:US
Mailing Address - Phone:518-382-2511
Mailing Address - Fax:
Practice Address - Street 1:1626 BALLTOWN RD
Practice Address - Street 2:C/O STUDENT SUPPORT SERVICES
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-2304
Practice Address - Country:US
Practice Address - Phone:518-382-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018412-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)