Provider Demographics
NPI:1326575283
Name:BROUGHTON, KJIRSTEN (CCC)
Entity Type:Individual
Prefix:
First Name:KJIRSTEN
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:KJIRSTEN
Other - Middle Name:
Other - Last Name:KROENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43089 E BIG MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:DENT
Mailing Address - State:MN
Mailing Address - Zip Code:56528-9134
Mailing Address - Country:US
Mailing Address - Phone:907-414-7058
Mailing Address - Fax:
Practice Address - Street 1:5516 S FORT APACHE RD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7679
Practice Address - Country:US
Practice Address - Phone:702-641-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist