Provider Demographics
NPI:1477289973
Name:REEVES, KRISTA DIANE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:DIANE
Last Name:REEVES
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 1:1519 DIAMOND CREEK LN
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-2105
Mailing Address - Country:US
Mailing Address - Phone:817-312-8119
Mailing Address - Fax:
Practice Address - Street 1:120 W KENNEDALE PKWY
Practice Address - Street 2:
Practice Address - City:KENNEDALE
Practice Address - State:TX
Practice Address - Zip Code:76060-2416
Practice Address - Country:US
Practice Address - Phone:817-563-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103523235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist