Provider Demographics
NPI:1760517304
Name:KRISTEK, JEANETTE M (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:M
Last Name:KRISTEK
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:409 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-1422
Mailing Address - Country:US
Mailing Address - Phone:417-678-3377
Mailing Address - Fax:417-678-4043
Practice Address - Street 1:409 W LOCUST ST
Practice Address - Street 2:AURORA REORGANIZED SCHOOL DIST R-8
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-1422
Practice Address - Country:US
Practice Address - Phone:417-678-3377
Practice Address - Fax:417-678-4043
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO469892004Medicaid