Provider Demographics
NPI:1003442500
Name:BAZINET, KRISTYNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTYNE
Middle Name:
Last Name:BAZINET
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 91ST CRES N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3846
Mailing Address - Country:US
Mailing Address - Phone:763-744-6360
Mailing Address - Fax:
Practice Address - Street 1:2600 FERNBROOK LN N STE 138
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4752
Practice Address - Country:US
Practice Address - Phone:952-544-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist