Provider Demographics
NPI:1275725251
Name:PARKER, KRISTEN LANE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:LANE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 HOUNDSLAKE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-8715
Mailing Address - Country:US
Mailing Address - Phone:678-523-4734
Mailing Address - Fax:
Practice Address - Street 1:1266 HOUNDSLAKE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-8715
Practice Address - Country:US
Practice Address - Phone:678-523-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist