Provider Demographics
NPI:1073605739
Name:TOLO, KRISTA LEEANN (SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:LEEANN
Last Name:TOLO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:TOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:41 WINTERMIST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7518
Mailing Address - Country:US
Mailing Address - Phone:714-481-2034
Mailing Address - Fax:714-551-1233
Practice Address - Street 1:41 WINTERMIST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7518
Practice Address - Country:US
Practice Address - Phone:520-481-2034
Practice Address - Fax:714-551-1233
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL4881235Z00000X
CACASLP24127235Z00000X
CACA24127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ745901Medicaid