Provider Demographics
NPI:1922523935
Name:SPANG, KRISTEN MICHELE (MA, SLP, TSSLD)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MICHELE
Last Name:SPANG
Suffix:
Gender:F
Credentials:MA, SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7956 77TH RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7523
Mailing Address - Country:US
Mailing Address - Phone:718-607-2778
Mailing Address - Fax:
Practice Address - Street 1:79-56 77TH ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-607-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026923-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist