Provider Demographics
NPI:1134785777
Name:WEGERT, KRISTIN FREIBURGER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:FREIBURGER
Last Name:WEGERT
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 1:2712 KINNEY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4976
Mailing Address - Country:US
Mailing Address - Phone:734-552-3841
Mailing Address - Fax:
Practice Address - Street 1:1221 W BEN WHITE BLVD STE B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7192
Practice Address - Country:US
Practice Address - Phone:512-615-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist