Provider Demographics
NPI:1457961906
Name:WINTER, KRISTIN B (MED, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:B
Last Name:WINTER
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 1:1762 SW CRANE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2232
Mailing Address - Country:US
Mailing Address - Phone:772-214-8656
Mailing Address - Fax:
Practice Address - Street 1:1762 SW CRANE CREEK CIR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2232
Practice Address - Country:US
Practice Address - Phone:772-214-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist