Provider Demographics
NPI:1497820286
Name:KINNARD, KRISTI K (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:K
Last Name:KINNARD
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:W174 GROVER CENTER
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-593-1404
Mailing Address - Fax:740-593-4433
Practice Address - Street 1:W174 GROVER CENTER
Practice Address - Street 2:OHIO UNIVERSITY THERAPY ASSOC
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-1404
Practice Address - Fax:740-593-4433
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000246469OtherANTHEM GRP #
OH4279041Medicare PIN