Provider Demographics
NPI:1295158673
Name:LINCOLN, KRISTEN LAUREL
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LAUREL
Last Name:LINCOLN
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 1:1901 E HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3904
Mailing Address - Country:US
Mailing Address - Phone:660-665-7774
Mailing Address - Fax:660-665-3281
Practice Address - Street 1:1815 E HAMILTON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3903
Practice Address - Country:US
Practice Address - Phone:660-665-5691
Practice Address - Fax:660-626-1421
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013040773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013040773OtherMISSOURI STATE BOARD OF REGISTRATION FOR THE HELAING ARTS
MOSPEECH LANGUAGE PATHOtherDEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION