Provider Demographics
NPI:1699825208
Name:MENENDEZ, KRISTY MICHELLE (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MICHELLE
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5011
Mailing Address - Country:US
Mailing Address - Phone:304-723-1592
Mailing Address - Fax:304-723-1594
Practice Address - Street 1:1307 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1747
Practice Address - Country:US
Practice Address - Phone:304-810-0812
Practice Address - Fax:304-810-0815
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0246231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist