Provider Demographics
NPI:1124380282
Name:SCHAFFER, KRISTIN MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIE
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2950 CHEROKEE ST NW
Mailing Address - Street 2:BUILDING 500
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6500
Mailing Address - Country:US
Mailing Address - Phone:678-895-5074
Mailing Address - Fax:678-903-5506
Practice Address - Street 1:2950 CHEROKEE ST NW
Practice Address - Street 2:BUILDING 500
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6500
Practice Address - Country:US
Practice Address - Phone:678-895-5074
Practice Address - Fax:678-903-5506
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSA11206235Z00000X
GASLP008541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist