Healthcare Provider Details

I. General information

NPI: 1205748191
Provider Name (Legal Business Name): KRISTEN BARANOWSKI CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SOUTHFIELD AVE APT 455
STAMFORD CT
06902-7280
US

IV. Provider business mailing address

28 SOUTHFIELD AVE APT 455
STAMFORD CT
06902-7280
US

V. Phone/Fax

Practice location:
  • Phone: 203-560-7131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14457682
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: