Provider Demographics
NPI:1922334747
Name:THORNE, KRISTI EASON (MA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:EASON
Last Name:THORNE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 HOULDSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5786
Mailing Address - Country:US
Mailing Address - Phone:704-455-4808
Mailing Address - Fax:
Practice Address - Street 1:644 ABINGTON DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2568
Practice Address - Country:US
Practice Address - Phone:704-239-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist