Provider Demographics
NPI:1891749453
Name:CHIN-AMBROSE, KRIS-ANN SIMONE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRIS-ANN
Middle Name:SIMONE
Last Name:CHIN-AMBROSE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:KRIS-ANN
Other - Middle Name:SIMONE
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:8830 S LAKE DASHA DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3011
Mailing Address - Country:US
Mailing Address - Phone:305-283-4800
Mailing Address - Fax:
Practice Address - Street 1:8830 S LAKE DASHA DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3011
Practice Address - Country:US
Practice Address - Phone:305-283-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5899235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887282100Medicaid
FLSA5899OtherPROFESSIONAL LICENSE
12031814OtherASHA CERTIFICATION