Provider Demographics
NPI:1558625087
Name:REBOUL, KRISTEN MARIE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:MARIE
Last Name:REBOUL
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BRAGG ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3108
Mailing Address - Country:US
Mailing Address - Phone:504-957-0449
Mailing Address - Fax:
Practice Address - Street 1:8300 EARHART BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4428
Practice Address - Country:US
Practice Address - Phone:504-866-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist