Provider Demographics
NPI:1225453228
Name:ANDRADE, KRISTIN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PLAZA WAY # 1018
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4601
Mailing Address - Country:US
Mailing Address - Phone:508-536-5599
Mailing Address - Fax:508-536-5534
Practice Address - Street 1:55 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2121
Practice Address - Country:US
Practice Address - Phone:508-997-1570
Practice Address - Fax:508-997-5370
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist