Provider Demographics
NPI:1942579123
Name:EDLUND, KRISTIN (MS SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:EDLUND
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1526
Mailing Address - Country:US
Mailing Address - Phone:845-216-0753
Mailing Address - Fax:
Practice Address - Street 1:725 BRADY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2701
Practice Address - Country:US
Practice Address - Phone:718-824-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-18
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist