Provider Demographics
NPI:1891155891
Name:SHAFFER, KRISTINA (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1301
Mailing Address - Country:US
Mailing Address - Phone:717-887-2997
Mailing Address - Fax:
Practice Address - Street 1:77 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1301
Practice Address - Country:US
Practice Address - Phone:717-887-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist