Healthcare Provider Details

I. General information

NPI: 1568208387
Provider Name (Legal Business Name): KRIS SINGLETON SLPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E BASELINE RD
MESA AZ
85204-6814
US

IV. Provider business mailing address

1900 E APACHE
TEMPE AZ
85281
US

V. Phone/Fax

Practice location:
  • Phone: 313-208-6272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17239
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: