Provider Demographics
NPI:1851864664
Name:MAUST, KRISTEN M (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:MAUST
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 1:279 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7126
Mailing Address - Country:US
Mailing Address - Phone:301-491-1192
Mailing Address - Fax:
Practice Address - Street 1:500 E SECOND ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4249
Practice Address - Country:US
Practice Address - Phone:301-777-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist