Provider Demographics
NPI:1114048089
Name:MARCUM, KRISTI (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:
Last Name:MARCUM
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 1:1005 TRUDE CT
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-9069
Mailing Address - Country:US
Mailing Address - Phone:606-739-9852
Mailing Address - Fax:606-739-9852
Practice Address - Street 1:101 13TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1653
Practice Address - Country:US
Practice Address - Phone:304-696-6939
Practice Address - Fax:304-529-1366
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0858235Z00000X
KY2303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist