Provider Demographics
NPI:1891825261
Name:SCANLON, KRISTI (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:SCANLON
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 1:6266 VISTA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-4346
Mailing Address - Country:US
Mailing Address - Phone:314-941-4203
Mailing Address - Fax:
Practice Address - Street 1:6266 VISTA VIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63051-4346
Practice Address - Country:US
Practice Address - Phone:314-941-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist