Provider Demographics
NPI:1801439328
Name:GRIEGO, KRISTEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GRIEGO
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 1:119 MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4451
Mailing Address - Country:US
Mailing Address - Phone:575-518-8815
Mailing Address - Fax:
Practice Address - Street 1:409 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4208
Practice Address - Country:US
Practice Address - Phone:505-907-1902
Practice Address - Fax:833-448-2997
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SLP7046235Z00000X
NMCF6772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist