Provider Demographics
NPI:1922876010
Name:WIEWORA, KRISTEN GREEN (CF-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GREEN
Last Name:WIEWORA
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MEADOW LANE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-3212
Mailing Address - Country:US
Mailing Address - Phone:901-486-6700
Mailing Address - Fax:
Practice Address - Street 1:2302 LLAMA DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4793
Practice Address - Country:US
Practice Address - Phone:501-268-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program