Provider Demographics
NPI:1831530161
Name:KRONK, KRISTEL CHERISSE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEL
Middle Name:CHERISSE
Last Name:KRONK
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 1:2721 LAVELLE DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1900
Mailing Address - Country:US
Mailing Address - Phone:636-933-1606
Mailing Address - Fax:
Practice Address - Street 1:MERCY HOSPITAL JEFFERSON
Practice Address - Street 2:1400 HWY 61 SOUTH
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019
Practice Address - Country:US
Practice Address - Phone:636-933-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008013799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist