Provider Demographics
NPI:1346535671
Name:VARGA, KRISTEN BURKHART (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:BURKHART
Last Name:VARGA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELYCE
Other - Last Name:BURKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:8811 17TH AVENUE CIR NW
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-8159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9020 58TH DR E
Practice Address - Street 2:#102
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-6107
Practice Address - Country:US
Practice Address - Phone:941-809-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17880235Z00000X
FLSA 12374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist