Provider Demographics
NPI:1396824504
Name:COONS, KRISTINE CARA (MS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:CARA
Last Name:COONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 AX HANDLE WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2855
Mailing Address - Country:US
Mailing Address - Phone:928-774-1045
Mailing Address - Fax:
Practice Address - Street 1:3036 N BOLDT DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0960
Practice Address - Country:US
Practice Address - Phone:928-773-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ478497Medicare ID - Type Unspecified