Provider Demographics
NPI:1790985158
Name:SLIVKA, KRISTEN LYNN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:SLIVKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYNN
Other - Last Name:BEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 MCCONNELL ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1723
Mailing Address - Country:US
Mailing Address - Phone:724-372-9160
Mailing Address - Fax:
Practice Address - Street 1:325 MCCONNELL ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1723
Practice Address - Country:US
Practice Address - Phone:724-372-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003178133V00000X
PADN004228133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered