Provider Demographics
NPI:1033533609
Name:KRISTEK, NICOLE ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:KRISTEK
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 1:1807 PICKENS LOOP
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2053
Mailing Address - Country:US
Mailing Address - Phone:206-334-7007
Mailing Address - Fax:
Practice Address - Street 1:1807 PICKENS LOOP
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2053
Practice Address - Country:US
Practice Address - Phone:206-334-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60411500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist