Provider Demographics
NPI:1013973270
Name:EAGERTON, KRISTEN (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:EAGERTON
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5783
Mailing Address - Country:US
Mailing Address - Phone:803-215-7788
Mailing Address - Fax:803-642-0674
Practice Address - Street 1:942 MILLBROOK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-0600
Practice Address - Country:US
Practice Address - Phone:803-215-7788
Practice Address - Fax:803-642-0674
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0493Medicaid