Provider Demographics
NPI:1225530694
Name:CHICK, KIRSTIE RAYLENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIE
Middle Name:RAYLENE
Last Name:CHICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KIRSTIE
Other - Middle Name:RAYLENE
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5501 SW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4130
Mailing Address - Country:US
Mailing Address - Phone:806-468-4343
Mailing Address - Fax:
Practice Address - Street 1:5501 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4130
Practice Address - Country:US
Practice Address - Phone:806-468-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist