Provider Demographics
NPI:1811455470
Name:KUCEY, KRISTINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KUCEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E SONTERRA BLVD APT 5310
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4731
Mailing Address - Country:US
Mailing Address - Phone:215-749-0849
Mailing Address - Fax:
Practice Address - Street 1:8221 PALISADES DR
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3402
Practice Address - Country:US
Practice Address - Phone:210-600-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist