Provider Demographics
NPI:1659402659
Name:WARING, KRISTINA M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:WARING
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 1:6200 GOLDEN WOOD LN
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-5015
Mailing Address - Country:US
Mailing Address - Phone:907-529-0332
Mailing Address - Fax:
Practice Address - Street 1:5660 B ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1641
Practice Address - Country:US
Practice Address - Phone:907-615-6049
Practice Address - Fax:907-802-4520
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK09147660OtherASHA CERTIFICATION
AKSP3396Medicaid
AK902489OtherAK BUSINESS LICENSE
AK160OtherSTATE LICENSE NUMBER