Provider Demographics
NPI:1508049891
Name:OQUIST, KERSTIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERSTIN
Middle Name:
Last Name:OQUIST
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 1:1630 E 2450 S
Mailing Address - Street 2:UNIT 63
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6228
Mailing Address - Country:US
Mailing Address - Phone:435-656-8858
Mailing Address - Fax:
Practice Address - Street 1:1630 E 2450 S
Practice Address - Street 2:UNIT 63
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6228
Practice Address - Country:US
Practice Address - Phone:435-656-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1422235Z00000X
UT354438-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist