Provider Demographics
NPI:1801311683
Name:PARK, KRISTIN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:PYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-8667
Mailing Address - Country:US
Mailing Address - Phone:484-366-1716
Mailing Address - Fax:
Practice Address - Street 1:4 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-8667
Practice Address - Country:US
Practice Address - Phone:484-366-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist