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NPI Code Detail

MEDICARE: MRS. KIRSTIE NICOLE SUBRY B.S., SLPA

MEDICARE: MRS. KIRSTIE NICOLE SUBRY B.S., SLPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12355S0801XSpeech-Language AssistantSPA3597CA

General Provider Information

NPI Number : 1245785039
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIRSTIE NICOLE SUBRY B.S., SLPA
Provider Business Mailing Address
First Line : 3031 W MARCH LN STE 117
Second Line :
City : STOCKTON
State : CA
Zip : 95219-6568
Country : US
Telephone Number : 209-952-2588
Fax Number : 209-952-2544
Provider Business Practice Location Address
First Line : 3031 W MARCH LN STE 117S
Second Line :
City : STOCKTON
State : CA
Zip : 95219-6500
Country : US
Telephone Number : 209-952-2588
Fax Number : 209-952-2544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2016
Last Update Date : 02/04/2026

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