Provider Demographics
NPI:1003415639
Name:DAYBACK, KRISTI (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:DAYBACK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7903
Mailing Address - Country:US
Mailing Address - Phone:908-489-2468
Mailing Address - Fax:
Practice Address - Street 1:52 CHARLES DR
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7903
Practice Address - Country:US
Practice Address - Phone:908-489-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00920600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist