Provider Demographics
NPI:1942844535
Name:TROGDON, KRISTEN MECHELE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MECHELE
Last Name:TROGDON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 US HIGHWAY 150
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-6071
Mailing Address - Country:US
Mailing Address - Phone:217-465-5391
Mailing Address - Fax:
Practice Address - Street 1:15601 US HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-6071
Practice Address - Country:US
Practice Address - Phone:217-465-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist