MEDICARE: KRISTEN MARIE HARRISON M.S.

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	8464	CA
2	235Z00000X	Speech-Language Pathologist	21848	CA

General Provider Information

NPI Number	:	1386070985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARIE HARRISON M.S.

Provider Business Mailing Address
First Line	:	624 EAST MARIPOSA DRIVE
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-7354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3002 DOW AVE STE 114
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-7247
Country	:	US
Telephone Number	:	714-731-4668
Fax Number	:	714-464-4668

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	04/27/2022

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Directions to “ KRISTEN MARIE HARRISON M.S.” Practice Location

Language	Start Address	Practice Location

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