Provider Demographics
NPI:1912375197
Name:MORFORD, KRISTIN (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MORFORD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:DEES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2934 PROMONTORY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1259
Mailing Address - Country:US
Mailing Address - Phone:916-521-8150
Mailing Address - Fax:
Practice Address - Street 1:210 PORTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1588
Practice Address - Country:US
Practice Address - Phone:925-743-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist