Provider Demographics
NPI:1831585447
Name:BURGOS, KRISTIN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BURGOS
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 1:154 NONANTUM ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2410
Mailing Address - Country:US
Mailing Address - Phone:631-835-8949
Mailing Address - Fax:
Practice Address - Street 1:154 NONANTUM ST
Practice Address - Street 2:APT 1
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2410
Practice Address - Country:US
Practice Address - Phone:631-835-8949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024629235Z00000X
MASP-9506-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist