Provider Demographics
NPI:1750644159
Name:BANAHAN, KRISTEN LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LYNN
Last Name:BANAHAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3526
Mailing Address - Country:US
Mailing Address - Phone:402-223-5277
Mailing Address - Fax:402-223-5279
Practice Address - Street 1:2320 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-1214
Practice Address - Country:US
Practice Address - Phone:402-228-9292
Practice Address - Fax:402-228-9191
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist