Provider Demographics
NPI:1841500964
Name:CREAHAN, KRISTI LYNN
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:LYNN
Last Name:CREAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SHADOWMOOR DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2239
Mailing Address - Country:US
Mailing Address - Phone:585-506-7932
Mailing Address - Fax:
Practice Address - Street 1:100 SCHOOL LN
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1242
Practice Address - Country:US
Practice Address - Phone:585-392-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020340-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03648271Medicaid