Provider Demographics
NPI:1376943415
Name:FIELDS, KRISTIN (RN, MSN, MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:RN, MSN, MA, CCC-SLP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8011 FOX RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5005
Mailing Address - Country:US
Mailing Address - Phone:720-938-0108
Mailing Address - Fax:970-221-1073
Practice Address - Street 1:8011 FOX RIDGE COURT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:720-938-0108
Practice Address - Fax:970-221-1073
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist