Provider Demographics
NPI:1659441137
Name:TAYLOR, KRISTIE MICHELLE (SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:MICHELLE
Last Name:TAYLOR
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 1:5270 DUKE ST
Mailing Address - Street 2:#205
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2943
Mailing Address - Country:US
Mailing Address - Phone:703-823-5698
Mailing Address - Fax:
Practice Address - Street 1:4800 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5070
Practice Address - Country:US
Practice Address - Phone:703-824-1244
Practice Address - Fax:703-824-1029
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist