Provider Demographics
NPI:1265067979
Name:REYNOLDS, KRISTIN ASHLEY
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ASHLEY
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S INTERSTATE 35 E APT 1227
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6904
Mailing Address - Country:US
Mailing Address - Phone:636-248-4294
Mailing Address - Fax:
Practice Address - Street 1:3200 S INTERSTATE 35 E APT 1227
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6904
Practice Address - Country:US
Practice Address - Phone:636-248-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist