Provider Demographics
NPI:1346526449
Name:DISTEFANO, KRISTEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18637 SUMMER HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-6783
Mailing Address - Country:US
Mailing Address - Phone:281-812-9519
Mailing Address - Fax:281-812-5719
Practice Address - Street 1:14705 WOODFOREST BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3258
Practice Address - Country:US
Practice Address - Phone:832-386-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist