Provider Demographics
NPI:1336886449
Name:REESE, KRISTIN MICHELLE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:REESE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 DUBLIN EASTMAN RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:GA
Mailing Address - Zip Code:31019-4005
Mailing Address - Country:US
Mailing Address - Phone:478-697-6299
Mailing Address - Fax:
Practice Address - Street 1:1729 DUBLIN EASTMAN RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:GA
Practice Address - Zip Code:31019-4005
Practice Address - Country:US
Practice Address - Phone:478-697-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist