Provider Demographics
NPI:1417102591
Name:ODDI, KRISTINE ANN (MS/CCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINE
Middle Name:ANN
Last Name:ODDI
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 BAUER RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-9471
Mailing Address - Country:US
Mailing Address - Phone:315-539-1161
Mailing Address - Fax:
Practice Address - Street 1:2719 BAUER RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-9471
Practice Address - Country:US
Practice Address - Phone:315-539-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0093751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist