Provider Demographics
NPI:1770980419
Name:WHITFIELD, KRISTIN JOY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JOY
Last Name:WHITFIELD
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 1:16840 FAIRVIEW CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2719
Mailing Address - Country:US
Mailing Address - Phone:262-385-8516
Mailing Address - Fax:
Practice Address - Street 1:16840 FAIRVIEW CT
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2719
Practice Address - Country:US
Practice Address - Phone:262-385-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist