Provider Demographics
NPI:1184935777
Name:ASHBURN, KRISTIN NOELLE (MAED, CCC - SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NOELLE
Last Name:ASHBURN
Suffix:
Gender:F
Credentials:MAED, CCC - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALLISON PARK
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1573
Mailing Address - Country:US
Mailing Address - Phone:978-448-2960
Mailing Address - Fax:
Practice Address - Street 1:6 ALLISON PARK
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1573
Practice Address - Country:US
Practice Address - Phone:978-448-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist