Provider Demographics
NPI:1639423072
Name:MCADAM, KRISTINE LYNN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LYNN
Last Name:MCADAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20788 BRANA RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-2949
Mailing Address - Country:US
Mailing Address - Phone:760-613-1683
Mailing Address - Fax:
Practice Address - Street 1:20788 BRANA RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-2949
Practice Address - Country:US
Practice Address - Phone:760-613-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60299412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist