Provider Demographics
NPI:1467722280
Name:VAGNARELLI, KRISTIN ERIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ERIN
Last Name:VAGNARELLI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1707
Mailing Address - Country:US
Mailing Address - Phone:570-242-5680
Mailing Address - Fax:
Practice Address - Street 1:802 MONROE ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1707
Practice Address - Country:US
Practice Address - Phone:570-242-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist