Provider Demographics
NPI:1255860201
Name:KANWETZ, KRISTINE MARIE (MS,SLP,CCC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:KANWETZ
Suffix:
Gender:F
Credentials:MS,SLP,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5474
Mailing Address - Country:US
Mailing Address - Phone:775-829-4700
Mailing Address - Fax:775-829-4710
Practice Address - Street 1:3700 GRANT DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5474
Practice Address - Country:US
Practice Address - Phone:775-829-4700
Practice Address - Fax:775-829-4710
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1991235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist