Provider Demographics
NPI:1467956185
Name:WHATLEY, KRISTEN COZETTE BYINGTON (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:COZETTE BYINGTON
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-6092
Mailing Address - Country:US
Mailing Address - Phone:571-377-6400
Mailing Address - Fax:703-257-8759
Practice Address - Street 1:10100 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-6092
Practice Address - Country:US
Practice Address - Phone:571-377-6400
Practice Address - Fax:703-257-8759
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist