Provider Demographics
NPI:1578843876
Name:NOLEN, KRISTA NICOLE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:NICOLE
Last Name:NOLEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:NICOLE
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:2615 COLONIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4910
Mailing Address - Country:US
Mailing Address - Phone:406-422-4213
Mailing Address - Fax:
Practice Address - Street 1:2615 COLONIAL DR STE A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4910
Practice Address - Country:US
Practice Address - Phone:406-422-4213
Practice Address - Fax:406-924-1903
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66772770Medicaid