Healthcare Provider Details

I. General information

NPI: 1699443200
Provider Name (Legal Business Name): KRISTEN LYNN KHOURI CF-SLP, TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 8TH AVE FL 6
NEW YORK NY
10018-3158
US

IV. Provider business mailing address

166 E 34TH ST APT 9K
NEW YORK NY
10016-4720
US

V. Phone/Fax

Practice location:
  • Phone: 917-286-5260
  • Fax:
Mailing address:
  • Phone: 914-400-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3018212
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number032216-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: