Provider Demographics
NPI:1821815721
Name:MANN, KRISTIN ELLIN (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELLIN
Last Name:MANN
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 1:930 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4835
Mailing Address - Country:US
Mailing Address - Phone:970-249-2405
Mailing Address - Fax:
Practice Address - Street 1:930 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4835
Practice Address - Country:US
Practice Address - Phone:970-249-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO352833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist