MEDICARE: KRISTEN WYATT

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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1346135415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN WYATT

Provider Business Mailing Address
First Line	:	1860 ATKINSON RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-5065
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 COTTAGE LN
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-6200
Country	:	US
Telephone Number	:	578-547-0226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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Directions to “ KRISTEN WYATT ” Practice Location

Language	Start Address	Practice Location

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