Provider Demographics
NPI:1255601506
Name:PIERCE, KRISTY (CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:PIERCE
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 1:116 CANTON CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-6379
Mailing Address - Country:US
Mailing Address - Phone:917-578-9563
Mailing Address - Fax:
Practice Address - Street 1:116 CANTON CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-6379
Practice Address - Country:US
Practice Address - Phone:917-578-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist