Provider Demographics
NPI:1407159569
Name:ANNESE, KRISTA G (MA, CCC-SP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:G
Last Name:ANNESE
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1114
Mailing Address - Country:US
Mailing Address - Phone:585-482-4836
Mailing Address - Fax:585-935-7428
Practice Address - Street 1:450 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1114
Practice Address - Country:US
Practice Address - Phone:585-482-4836
Practice Address - Fax:585-935-7428
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0061171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist