Provider Demographics
NPI:1700125317
Name:WEBSTER, KRISTINA KAY (MS/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:KAY
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MS/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:S105W30790 PHANTOM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9137
Mailing Address - Country:US
Mailing Address - Phone:262-271-0291
Mailing Address - Fax:
Practice Address - Street 1:S105W30790 PHANTOM VIEW DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9137
Practice Address - Country:US
Practice Address - Phone:262-271-0291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI433-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist