Provider Demographics
NPI:1881416857
Name:CARDER, KRISTIN A (SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:A
Last Name:CARDER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WEATHERSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-8093
Mailing Address - Country:US
Mailing Address - Phone:770-823-8338
Mailing Address - Fax:
Practice Address - Street 1:25 WEATHERSTONE WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-8093
Practice Address - Country:US
Practice Address - Phone:770-823-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist