Provider Demographics
NPI:1083262307
Name:LAMPHERE, KRISTA L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:LAMPHERE
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 1:41689 ENTERPRISE CIR N STE 118
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5630
Mailing Address - Country:US
Mailing Address - Phone:951-541-0615
Mailing Address - Fax:951-296-1943
Practice Address - Street 1:41689 ENTERPRISE CIR N STE 118
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5630
Practice Address - Country:US
Practice Address - Phone:951-541-0615
Practice Address - Fax:951-296-1943
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP28287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093034779OtherGROUP NPI