Provider Demographics
NPI:1881066116
Name:BJORKMAN, KRISTIN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BJORKMAN
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 1:1620 CALLE LAS BOLAS
Mailing Address - Street 2:UNIT D
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4929
Mailing Address - Country:US
Mailing Address - Phone:949-735-1084
Mailing Address - Fax:
Practice Address - Street 1:1620 CALLE LAS BOLAS
Practice Address - Street 2:UNIT D
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4929
Practice Address - Country:US
Practice Address - Phone:949-735-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist