Provider Demographics
NPI:1003505082
Name:CHAVEZ-CANTRES, KRISTEN MELISSA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MELISSA
Last Name:CHAVEZ-CANTRES
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 1:785 LUMINARY CIR UNIT 105
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-6636
Mailing Address - Country:US
Mailing Address - Phone:813-784-4683
Mailing Address - Fax:
Practice Address - Street 1:1634 SALADINO ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-5425
Practice Address - Country:US
Practice Address - Phone:321-684-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist