Healthcare Provider Details

I. General information

NPI: 1659200590
Provider Name (Legal Business Name): KRISTINA HAGGERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SEYMOUR AVE
LYNN MA
01902-1907
US

IV. Provider business mailing address

18 SEYMOUR AVE
LYNN MA
01902-1907
US

V. Phone/Fax

Practice location:
  • Phone: 508-479-5019
  • Fax: 508-479-5019
Mailing address:
  • Phone: 508-479-5019
  • Fax: 508-479-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: