Provider Demographics
NPI:1609180876
Name:HORTON, KRISTIE (MS-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:
Last Name:HORTON
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 1:3001 WILMOT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2662
Mailing Address - Country:US
Mailing Address - Phone:803-622-0770
Mailing Address - Fax:
Practice Address - Street 1:3001 WILMOT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2662
Practice Address - Country:US
Practice Address - Phone:803-622-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist