Provider Demographics
NPI:1922242205
Name:ST.NICHOLAS, KRISTEN H (SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:H
Last Name:ST.NICHOLAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LELAND LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5038
Mailing Address - Country:US
Mailing Address - Phone:631-591-4500
Mailing Address - Fax:631-283-6891
Practice Address - Street 1:30 PINE ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4960
Practice Address - Country:US
Practice Address - Phone:631-591-4800
Practice Address - Fax:631-283-6891
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist