Provider Demographics
NPI:1639489792
Name:CONDON, KRISTINE ROWLEY (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ROWLEY
Last Name:CONDON
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 NORMANDY VLG
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-6907
Mailing Address - Country:US
Mailing Address - Phone:845-627-1221
Mailing Address - Fax:
Practice Address - Street 1:657 NORMANDY VLG
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-6907
Practice Address - Country:US
Practice Address - Phone:845-627-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008840-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist