Provider Demographics
NPI:1295862704
Name:BURRELL, KRISTIN GREILICK (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:GREILICK
Last Name:BURRELL
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 1:100 TAMAL PLZ
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1125
Mailing Address - Country:US
Mailing Address - Phone:415-823-1258
Mailing Address - Fax:
Practice Address - Street 1:100 TAMAL PLZ
Practice Address - Street 2:SUITE 102
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1125
Practice Address - Country:US
Practice Address - Phone:415-823-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist