Provider Demographics
NPI:1194195354
Name:KT SLP, PLLC
Entity Type:Organization
Organization Name:KT SLP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURABELIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, TSSLD
Authorized Official - Phone:347-527-6837
Mailing Address - Street 1:3020 AVENUE Y
Mailing Address - Street 2:APT 8E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1452
Mailing Address - Country:US
Mailing Address - Phone:347-527-6837
Mailing Address - Fax:
Practice Address - Street 1:3020 AVENUE Y
Practice Address - Street 2:APT 8E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1452
Practice Address - Country:US
Practice Address - Phone:347-527-6837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty