Healthcare Provider Details

I. General information

NPI: 1447726633
Provider Name (Legal Business Name): KRISTEN ALBERICO MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 WALLINGWOOD DR BLDG 2
AUSTIN TX
78746-6900
US

IV. Provider business mailing address

2525 WALLINGWOOD DR BLDG 2
AUSTIN TX
78746-6900
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-6179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA16140
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number112147
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: