Provider Demographics
NPI:1073808523
Name:CUMMINGS, KRISTIN SUMSTAD (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:SUMSTAD
Last Name:CUMMINGS
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 1:6242 21ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4802
Mailing Address - Country:US
Mailing Address - Phone:727-459-9930
Mailing Address - Fax:
Practice Address - Street 1:1923 DOLPHIN BLVD S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-3809
Practice Address - Country:US
Practice Address - Phone:727-743-3369
Practice Address - Fax:727-345-9870
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist