Healthcare Provider Details

I. General information

NPI: 1376407767
Provider Name (Legal Business Name): KRISTIN CHISUM M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GOULD ST STE 290
NEEDHAM MA
02494-2397
US

IV. Provider business mailing address

67 CLAYPIT HILL RD
WAYLAND MA
01778-2004
US

V. Phone/Fax

Practice location:
  • Phone: 781-400-2605
  • Fax:
Mailing address:
  • Phone: 781-400-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP7323
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: