Provider Demographics
NPI:1649563339
Name:DARE, KRISTEN MARIE (SLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:MARIE
Last Name:DARE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LA COSTA CIR
Mailing Address - Street 2:#8
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3528
Mailing Address - Country:US
Mailing Address - Phone:631-275-2033
Mailing Address - Fax:
Practice Address - Street 1:960 LA COSTA CIR
Practice Address - Street 2:#8
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3528
Practice Address - Country:US
Practice Address - Phone:631-275-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist