Provider Demographics
NPI:1407189277
Name:PERRONE, KRISTEN L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:PERRONE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:DEYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:63 W COURT DR
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2310
Mailing Address - Country:US
Mailing Address - Phone:631-834-8697
Mailing Address - Fax:
Practice Address - Street 1:111 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1827
Practice Address - Country:US
Practice Address - Phone:978-921-1182
Practice Address - Fax:978-921-2982
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY023835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist