Provider Demographics
NPI:1598901381
Name:FAZIO, KRISTIE M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:M
Last Name:FAZIO
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 1:8 RICHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3228
Mailing Address - Country:US
Mailing Address - Phone:631-223-3228
Mailing Address - Fax:
Practice Address - Street 1:880 OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1011
Practice Address - Country:US
Practice Address - Phone:516-624-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-28
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist