Provider Demographics
NPI:1336777374
Name:PARENTEAU, KRISTIN E'LISE
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:E'LISE
Last Name:PARENTEAU
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 1:999 ORONOQUE LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1379
Mailing Address - Country:US
Mailing Address - Phone:203-870-2022
Mailing Address - Fax:203-386-1144
Practice Address - Street 1:256 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4416
Practice Address - Country:US
Practice Address - Phone:860-666-5689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist