Provider Demographics
NPI:1447746045
Name:DERINGER, KRISTIN L
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:DERINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N NOVA RD # 129
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5124
Mailing Address - Country:US
Mailing Address - Phone:609-980-8162
Mailing Address - Fax:
Practice Address - Street 1:226 N NOVA RD # 129
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5124
Practice Address - Country:US
Practice Address - Phone:609-980-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist