Provider Demographics
NPI:1437100575
Name:CHISM, KRISTIN ANN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANN
Last Name:CHISM
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 1:4006 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8553
Mailing Address - Country:US
Mailing Address - Phone:972-377-7289
Mailing Address - Fax:972-377-7657
Practice Address - Street 1:2611 INTERNET BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9085
Practice Address - Country:US
Practice Address - Phone:972-377-7289
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist