Healthcare Provider Details

I. General information

NPI: 1043436173
Provider Name (Legal Business Name): KRISTA ANNE JURKONIS MHS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 CLIFTON LN APT 20
NASHVILLE TN
37204-3244
US

IV. Provider business mailing address

1112 CLIFTON LN APT 20
NASHVILLE TN
37204-3244
US

V. Phone/Fax

Practice location:
  • Phone: 630-732-5938
  • Fax:
Mailing address:
  • Phone: 630-732-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.007697
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5344
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: