Provider Demographics
NPI:1437225646
Name:VINCENT, KRISTEN ELIZABETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1840 N LINCOLN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5812
Mailing Address - Country:US
Mailing Address - Phone:813-789-5024
Mailing Address - Fax:
Practice Address - Street 1:4711 GOLF RD STE 1100
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1249
Practice Address - Country:US
Practice Address - Phone:847-763-7930
Practice Address - Fax:847-933-0874
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6281235Z00000X
IL146.010616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811973200Medicaid
FL886750000Medicaid
IL1437225646Medicaid
FLS2247OtherBCBS OF FLORIDA