Provider Demographics
NPI:1174822746
Name:YTKIN, KRISTA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:YTKIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9194
Mailing Address - Country:US
Mailing Address - Phone:610-390-2423
Mailing Address - Fax:
Practice Address - Street 1:4578 OAKWOOD LN
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8670
Practice Address - Country:US
Practice Address - Phone:570-851-0738
Practice Address - Fax:610-365-2171
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA080119906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist