Provider Demographics
NPI:1114371317
Name:BAHL, KRISTIN (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BAHL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:APPLEGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12058 COUNTY ROAD 77
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NE
Mailing Address - Zip Code:69334-2713
Mailing Address - Country:US
Mailing Address - Phone:308-641-1758
Mailing Address - Fax:
Practice Address - Street 1:12058 COUNTY ROAD 77
Practice Address - Street 2:
Practice Address - City:BAYARD
Practice Address - State:NE
Practice Address - Zip Code:69334-2713
Practice Address - Country:US
Practice Address - Phone:308-641-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist