Provider Demographics
NPI:1457630014
Name:KLINE, KRISTA (MSSLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:MSSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-1702
Mailing Address - Country:US
Mailing Address - Phone:765-642-0201
Mailing Address - Fax:
Practice Address - Street 1:5325 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-1702
Practice Address - Country:US
Practice Address - Phone:765-642-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006398235Z00000X
IN22007474A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA45084OtherOPTIMA
VA194411OtherANTHEM
VA49-7850-1Medicaid
VA45084OtherOPTIMA