Provider Demographics
NPI:1619302981
Name:SCHAEFER, KRISTEN LEE (MA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEE
Other - Last Name:PAPESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:12180 RAMONA AVE
Mailing Address - Street 2:APARTMENT 72
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2278
Mailing Address - Country:US
Mailing Address - Phone:408-891-7651
Mailing Address - Fax:
Practice Address - Street 1:12180 RAMONA AVE
Practice Address - Street 2:APARTMENT 72
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2278
Practice Address - Country:US
Practice Address - Phone:408-891-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE 8152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist