Provider Demographics
NPI:1790278687
Name:PEACE, KRISTIN NICHELLE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICHELLE
Last Name:PEACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 BANDERA DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1415
Mailing Address - Country:US
Mailing Address - Phone:804-986-8512
Mailing Address - Fax:
Practice Address - Street 1:5200 FRANCISTOWN RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2841
Practice Address - Country:US
Practice Address - Phone:804-527-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist