Provider Demographics
NPI:1093961096
Name:GEORGE, KRISTY J (MEDCCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:J
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MEDCCC-SLP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:J
Other - Last Name:CARBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDCCC-SLP
Mailing Address - Street 1:5661 97TH WAY N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3433
Mailing Address - Country:US
Mailing Address - Phone:813-598-1513
Mailing Address - Fax:
Practice Address - Street 1:5661 97TH WAY N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3433
Practice Address - Country:US
Practice Address - Phone:813-598-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist