Provider Demographics
NPI:1700222320
Name:BELL, KRISTEN ELISABETH
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ELISABETH
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 W RED BUD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4768
Mailing Address - Country:US
Mailing Address - Phone:217-370-5720
Mailing Address - Fax:
Practice Address - Street 1:4422 W RED BUD DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-4768
Practice Address - Country:US
Practice Address - Phone:217-370-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002403235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist