Provider Demographics
NPI:1659657898
Name:WEBER, KRISTEN MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE
Last Name:WEBER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:HODOVANEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:970 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3643
Mailing Address - Country:US
Mailing Address - Phone:518-881-0600
Mailing Address - Fax:
Practice Address - Street 1:970 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3643
Practice Address - Country:US
Practice Address - Phone:518-881-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018395-1235Z00000X
DCSLP00001484235Z00000X
FLSA19560235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist