Provider Demographics
NPI:1740534155
Name:FITZGERALD, KRISTY A (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:A
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:KRISTY
Other - Middle Name:A
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:121 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3400
Mailing Address - Country:US
Mailing Address - Phone:701-739-5497
Mailing Address - Fax:
Practice Address - Street 1:121 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3400
Practice Address - Country:US
Practice Address - Phone:701-739-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist