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General NPI Number Information
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NPI Number | 1033800602
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Entity Type | Individual
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Provider Name | KRISTEN REBECCA MAYNARD M.S., SLP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1013 CENTER DR
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City | RICHMOND
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State | KY
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Zip | 40475-3841
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Country | US
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Telephone | 859-444-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 109 WIND HAVEN DR STE 100
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8010
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Country | US
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Telephone | 859-224-2273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 285828
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 291977
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License Number State | KY
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