Provider Demographics
NPI:1326520883
Name:GARDINIER, KRISTINE DISCHIAVI (CCCSLP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:DISCHIAVI
Last Name:GARDINIER
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROOT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2520
Mailing Address - Country:US
Mailing Address - Phone:315-733-1055
Mailing Address - Fax:
Practice Address - Street 1:241 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3452
Practice Address - Country:US
Practice Address - Phone:315-272-1600
Practice Address - Fax:315-272-1780
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist