Provider Demographics
NPI:1245785039
Name:SUBRY, KIRSTIE NICOLE (BS, SLPA)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIE
Middle Name:NICOLE
Last Name:SUBRY
Suffix:
Gender:F
Credentials:BS, SLPA
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Mailing Address - Street 1:4719 QUAIL LAKES DR # G240
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5267
Mailing Address - Country:US
Mailing Address - Phone:209-952-2588
Mailing Address - Fax:209-952-2544
Practice Address - Street 1:3031 W MARCH LN STE 117S
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6500
Practice Address - Country:US
Practice Address - Phone:209-952-2588
Practice Address - Fax:209-952-2544
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CASPA35972355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant