Provider Demographics
NPI:1952517088
Name:HOUSEL, KRISTIN MICHELE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MICHELE
Last Name:HOUSEL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:MICHELE
Other - Last Name:CORREDINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1326 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610
Mailing Address - Country:US
Mailing Address - Phone:585-626-5533
Mailing Address - Fax:
Practice Address - Street 1:80 ROCKWOOD PLACE SUITE 224
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610
Practice Address - Country:US
Practice Address - Phone:585-626-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03607398Medicaid