Provider Demographics
NPI:1578836664
Name:THOMPSON, KRISTINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:THOMPSON
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 1:1201 IVY RD
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2309
Mailing Address - Country:US
Mailing Address - Phone:732-722-8602
Mailing Address - Fax:
Practice Address - Street 1:1201 IVY RD
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2309
Practice Address - Country:US
Practice Address - Phone:732-722-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00456300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist