Provider Demographics
NPI:1982005831
Name:CLAYTON, KRISTINE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41555 COOK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5184
Mailing Address - Country:US
Mailing Address - Phone:760-837-0033
Mailing Address - Fax:760-837-1013
Practice Address - Street 1:41555 COOK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5184
Practice Address - Country:US
Practice Address - Phone:760-837-0033
Practice Address - Fax:760-837-1013
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14513OtherSPEECH LANGUAGE AND HEARING