Provider Demographics
NPI:1437319738
Name:PORCELLI, KRISTIN (MSCCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PORCELLI
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8346
Mailing Address - Country:US
Mailing Address - Phone:910-686-0540
Mailing Address - Fax:
Practice Address - Street 1:721 SQUIRE LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8346
Practice Address - Country:US
Practice Address - Phone:910-686-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist