Provider Demographics
NPI:1033841382
Name:ESTRADA, KEVIN JR (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:ESTRADA
Suffix:JR
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 BRUYNSWICK RD APT A
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-4130
Mailing Address - Country:US
Mailing Address - Phone:845-837-2216
Mailing Address - Fax:
Practice Address - Street 1:31 KINNEBROOK ROAD
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12561
Practice Address - Country:US
Practice Address - Phone:845-837-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist