Provider Demographics
NPI:1023565918
Name:WYATT, KRISTEN M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:WYATT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:31 HOSIER ST
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-9300
Mailing Address - Country:US
Mailing Address - Phone:302-436-1000
Mailing Address - Fax:
Practice Address - Street 1:31 HOSIER ST
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-9300
Practice Address - Country:US
Practice Address - Phone:302-436-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0001519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist