Provider Demographics
NPI:1619913183
Name:SEAQUIST, KRISTEN NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:SEAQUIST
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 1:175 COTILLION CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1580
Mailing Address - Country:US
Mailing Address - Phone:850-524-1030
Mailing Address - Fax:
Practice Address - Street 1:175 COTILLION CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1580
Practice Address - Country:US
Practice Address - Phone:850-524-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist