Provider Demographics
NPI:1720209133
Name:POE, KRISTY DAWN (MS, CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:DAWN
Last Name:POE
Suffix:
Gender:F
Credentials:MS, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 HIGHWAY 31 N
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-9781
Mailing Address - Country:US
Mailing Address - Phone:501-882-5605
Mailing Address - Fax:
Practice Address - Street 1:2233 HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-9781
Practice Address - Country:US
Practice Address - Phone:501-882-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist