Provider Demographics
NPI:1386179901
Name:KLEINHENZ, KRISTEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KLEINHENZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 QUICK RD
Mailing Address - Street 2:
Mailing Address - City:PENINSULA
Mailing Address - State:OH
Mailing Address - Zip Code:44264-9706
Mailing Address - Country:US
Mailing Address - Phone:330-928-9074
Mailing Address - Fax:330-928-5645
Practice Address - Street 1:4451 QUICK RD
Practice Address - Street 2:
Practice Address - City:PENINSULA
Practice Address - State:OH
Practice Address - Zip Code:44264-9706
Practice Address - Country:US
Practice Address - Phone:330-928-7420
Practice Address - Fax:330-928-5645
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-SP-6303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist