Provider Demographics
NPI:1134416548
Name:CAMPOS, KRISTEN L
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 AVENIDA DE ESTRELLAS
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-2701
Mailing Address - Country:US
Mailing Address - Phone:956-639-4146
Mailing Address - Fax:
Practice Address - Street 1:1026 AVENIDA DE ESTRELLAS
Practice Address - Street 2:
Practice Address - City:RANCHO VIEJO
Practice Address - State:TX
Practice Address - Zip Code:78575-2701
Practice Address - Country:US
Practice Address - Phone:956-639-4146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361612355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36161OtherSTATE LICENSE