Provider Demographics
NPI:1760739734
Name:BURNS, KRISTEN LEIGH FAHEY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEIGH FAHEY
Last Name:BURNS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LEDGEFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6740
Mailing Address - Country:US
Mailing Address - Phone:207-420-2336
Mailing Address - Fax:
Practice Address - Street 1:33 LEDGEFIELD CIR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6740
Practice Address - Country:US
Practice Address - Phone:207-420-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2246235Z00000X
NHP-0521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist