Provider Demographics
NPI:1437292844
Name:CAMERON, KRISTEN LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LYNN
Last Name:CAMERON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7306 COATBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-3874
Mailing Address - Country:US
Mailing Address - Phone:865-544-7912
Mailing Address - Fax:865-475-1859
Practice Address - Street 1:1515 MEADOW SPRING DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2047
Practice Address - Country:US
Practice Address - Phone:865-475-1858
Practice Address - Fax:865-475-1859
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN3071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440691Medicaid
TN4113704OtherBLUECROSS BLUESHIELD ID