Provider Demographics
NPI:1033423660
Name:WITT, KRISTOPHER DEWAYNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:DEWAYNE
Last Name:WITT
Suffix:
Gender:M
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 1:121 BEN BOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-9703
Mailing Address - Country:US
Mailing Address - Phone:276-988-2515
Mailing Address - Fax:
Practice Address - Street 1:121 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9703
Practice Address - Country:US
Practice Address - Phone:276-988-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist