Provider Demographics
NPI:1144571522
Name:MESSENGER, KRISTIN M (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:MESSENGER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6620
Mailing Address - Country:US
Mailing Address - Phone:304-288-8132
Mailing Address - Fax:
Practice Address - Street 1:509 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-6620
Practice Address - Country:US
Practice Address - Phone:304-288-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVP/SLP-0545235Z00000X
WV1468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist