Healthcare Provider Details

I. General information

NPI: 1114048089
Provider Name (Legal Business Name): KRISTI MARCUM MA CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 13TH ST
HUNTINGTON WV
25701-1653
US

IV. Provider business mailing address

1005 TRUDE CT
CATLETTSBURG KY
41129-9069
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-6939
  • Fax: 304-529-1366
Mailing address:
  • Phone: 606-739-9852
  • Fax: 606-739-9852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0858
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2303
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: