Provider Demographics
NPI:1811286370
Name:DORRIS, KRISTIN THOMAS (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:THOMAS
Last Name:DORRIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 GARNER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2331
Mailing Address - Country:US
Mailing Address - Phone:615-382-7423
Mailing Address - Fax:
Practice Address - Street 1:2107 PARK PLAZA DR
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3937
Practice Address - Country:US
Practice Address - Phone:615-382-0500
Practice Address - Fax:615-382-0501
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist