Provider Demographics
NPI:1760855423
Name:WORDEN, KRISTA
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:WORDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:DURR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BS
Mailing Address - Street 1:4262 W BEEHIVE PEAK CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-8509
Mailing Address - Country:US
Mailing Address - Phone:520-661-6231
Mailing Address - Fax:
Practice Address - Street 1:1795 W DREXEL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-1315
Practice Address - Country:US
Practice Address - Phone:520-908-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP8872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist