Provider Demographics
NPI:1083374268
Name:FABRICZI, KRISTEN MICHELE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MICHELE
Last Name:FABRICZI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 JOHNS LN
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08853-4094
Mailing Address - Country:US
Mailing Address - Phone:908-229-1011
Mailing Address - Fax:
Practice Address - Street 1:221 JOHNS LN
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08853-4094
Practice Address - Country:US
Practice Address - Phone:908-229-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00398500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty