Provider Demographics
NPI:1306725452
Name:ALLEN, KRISTINA GRACE (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:GRACE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-2401
Mailing Address - Country:US
Mailing Address - Phone:217-825-2225
Mailing Address - Fax:
Practice Address - Street 1:805 N CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1450
Practice Address - Country:US
Practice Address - Phone:217-824-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.018404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist