Provider Demographics
NPI:1912212861
Name:GAVERN, KRISTEN YVONNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:YVONNE
Last Name:GAVERN
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 1:6616 BAY ST
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-2126
Mailing Address - Country:US
Mailing Address - Phone:727-388-4906
Mailing Address - Fax:
Practice Address - Street 1:6616 BAY ST
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-2126
Practice Address - Country:US
Practice Address - Phone:727-388-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist