Provider Demographics
NPI:1770098642
Name:CHARBONNEAU, KRISTI (MA,CCC/SLP)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:CHARBONNEAU
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 1:236 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6140
Mailing Address - Country:US
Mailing Address - Phone:970-290-3538
Mailing Address - Fax:
Practice Address - Street 1:236 MALLARD CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-6140
Practice Address - Country:US
Practice Address - Phone:970-290-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist