Provider Demographics
NPI:1417727397
Name:THOMPSON, KESTRA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KESTRA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 E ARAPAHOE RD STE 118
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3851
Mailing Address - Country:US
Mailing Address - Phone:720-791-2881
Mailing Address - Fax:
Practice Address - Street 1:11211 E ARAPAHOE RD STE 118
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3851
Practice Address - Country:US
Practice Address - Phone:720-791-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14396089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist