Provider Demographics
NPI:1396491791
Name:KAELIN, KRISTEN JUDITH (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JUDITH
Last Name:KAELIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9228 LEON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2831
Mailing Address - Country:US
Mailing Address - Phone:267-515-2456
Mailing Address - Fax:
Practice Address - Street 1:9228 LEON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2831
Practice Address - Country:US
Practice Address - Phone:267-515-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist