Provider Demographics
NPI:1497454904
Name:SMITH, KRISTIN SCHAEFER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SCHAEFER
Last Name:SMITH
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 1:4 ISLAND AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1673
Mailing Address - Country:US
Mailing Address - Phone:603-556-1750
Mailing Address - Fax:
Practice Address - Street 1:7 GREENLEAF WOODS DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5444
Practice Address - Country:US
Practice Address - Phone:603-556-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3428235Z00000X
NH1234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist