Provider Demographics
NPI:1346402112
Name:KLEINKNECHT, CHRYSTIE LEE (MS)
Entity Type:Individual
Prefix:
First Name:CHRYSTIE
Middle Name:LEE
Last Name:KLEINKNECHT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CHRYSTIE
Other - Middle Name:LEE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4155 E JASPER DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8461
Mailing Address - Country:US
Mailing Address - Phone:480-466-4833
Mailing Address - Fax:
Practice Address - Street 1:21630 N 19TH AVE STE B3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2717
Practice Address - Country:US
Practice Address - Phone:480-488-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist