Provider Demographics
NPI:1164839957
Name:WHITE, KRISTINA HOPE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:HOPE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 MEDINA DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3185
Mailing Address - Country:US
Mailing Address - Phone:325-234-1497
Mailing Address - Fax:
Practice Address - Street 1:6016 MEDINA DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3185
Practice Address - Country:US
Practice Address - Phone:325-234-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist