Provider Demographics
NPI:1275881690
Name:WILSON, KRISTIN PORRITT (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:PORRITT
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:RENEE
Other - Last Name:PORRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:8610 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3004
Mailing Address - Country:US
Mailing Address - Phone:206-985-6646
Mailing Address - Fax:
Practice Address - Street 1:8610 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-3004
Practice Address - Country:US
Practice Address - Phone:206-985-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60071449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist