Provider Demographics
NPI:1659501484
Name:VAN TASSEL, KRISTINE ERIN (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ERIN
Last Name:VAN TASSEL
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 1:796 SCHWANGER RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9606
Mailing Address - Country:US
Mailing Address - Phone:717-361-7353
Mailing Address - Fax:
Practice Address - Street 1:2137 EMBASSY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2876
Practice Address - Country:US
Practice Address - Phone:717-569-8972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist