Provider Demographics
NPI:1245369701
Name:CHREST, KRISTINE DAWN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:DAWN
Last Name:CHREST
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:DAWN
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 PADDLE BOAT WAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9268
Mailing Address - Country:US
Mailing Address - Phone:410-688-4303
Mailing Address - Fax:
Practice Address - Street 1:1445 BLUEWATER WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-7923
Practice Address - Country:US
Practice Address - Phone:410-688-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11887235Z00000X
SCSLP.8729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419800000Medicaid