Provider Demographics
NPI:1558752030
Name:MADAY, KRISTINE N (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:N
Last Name:MADAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S UNION BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3126
Mailing Address - Country:US
Mailing Address - Phone:719-305-8000
Mailing Address - Fax:719-305-8001
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3126
Practice Address - Country:US
Practice Address - Phone:719-305-8000
Practice Address - Fax:719-305-8001
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9125235Z00000X
COSLP.0001929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94278032Medicaid