Provider Demographics
NPI:1508962671
Name:WADELL, KRISTAN COCHRANE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:COCHRANE
Last Name:WADELL
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 1:10608 HOBBS STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2671
Mailing Address - Country:US
Mailing Address - Phone:502-253-9565
Mailing Address - Fax:502-253-9655
Practice Address - Street 1:10608 HOBBS STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2671
Practice Address - Country:US
Practice Address - Phone:502-253-9565
Practice Address - Fax:502-253-9566
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000372922OtherANTHEM BC/BS ID. #