Provider Demographics
NPI:1790156800
Name:SPATARO, KRISTEN ALEXIS (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALEXIS
Last Name:SPATARO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MULIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:35 MARLBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1632
Mailing Address - Country:US
Mailing Address - Phone:917-747-8034
Mailing Address - Fax:
Practice Address - Street 1:500 BI COUNTY BLVD STE 114
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3931
Practice Address - Country:US
Practice Address - Phone:631-753-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021827-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist