Provider Demographics
NPI:1780019554
Name:WARREN, KRISTIN NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:WARREN
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 1:4100 JURUPA ST
Mailing Address - Street 2:SUITE #108
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1420
Mailing Address - Country:US
Mailing Address - Phone:909-390-1313
Mailing Address - Fax:
Practice Address - Street 1:4100 JURUPA ST
Practice Address - Street 2:SUITE #108
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-1420
Practice Address - Country:US
Practice Address - Phone:909-390-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist