Provider Demographics
NPI:1417412800
Name:BECKNER, KRISTEN (MS ED, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BECKNER
Suffix:
Gender:F
Credentials:MS ED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MYBET CT
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-9181
Mailing Address - Country:US
Mailing Address - Phone:252-305-0884
Mailing Address - Fax:
Practice Address - Street 1:111 MYBET CT
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-9181
Practice Address - Country:US
Practice Address - Phone:252-305-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist