Provider Demographics
NPI:1417230699
Name:MCOMBER, KRISTIN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:MCOMBER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:WAYLAND-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:181 HULBURT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2474
Mailing Address - Country:US
Mailing Address - Phone:585-421-2170
Mailing Address - Fax:585-421-2173
Practice Address - Street 1:181 HULBURT RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2474
Practice Address - Country:US
Practice Address - Phone:585-421-2170
Practice Address - Fax:585-421-2173
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008558-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist