Provider Demographics
NPI:1003089301
Name:BROWN, KRISTY K (ST)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:K
Last Name:BROWN
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:K
Other - Last Name:HARRAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:2725 WATER RIDGE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4580
Mailing Address - Country:US
Mailing Address - Phone:704-831-5065
Mailing Address - Fax:704-831-5066
Practice Address - Street 1:2919 S ELLSWORTH RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2164
Practice Address - Country:US
Practice Address - Phone:480-358-6767
Practice Address - Fax:480-358-6885
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSLP5805OtherAZ LICENSE