Provider Demographics
NPI:1689284069
Name:FERNANDEZ, KRISTEN SKONBERG (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:SKONBERG
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:ALEXA
Other - Last Name:SKONBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:839 LOUQUE PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1733
Mailing Address - Country:US
Mailing Address - Phone:202-841-2852
Mailing Address - Fax:
Practice Address - Street 1:839 LOUQUE PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-1733
Practice Address - Country:US
Practice Address - Phone:202-841-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist