MEDICARE: MS. KRISTY A CONNOR M.S. CCC-SLP

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	7759	NC

General Provider Information

NPI Number	:	1750539938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTY A CONNOR M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	4695 HACKBERRY GROVE CIR
Second Line	:	APT 1922
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-2435
Country	:	US
Telephone Number	:	631-806-6462
Fax Number	:

Provider Business Practice Location Address
First Line	:	4695 HACKBERRY GROVE CIR
Second Line	:	APT 1922
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-2435
Country	:	US
Telephone Number	:	631-806-6462
Fax Number	:

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

Provider Enumeration Date	:	08/31/2008
Last Update Date	:	08/31/2008

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