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General NPI Number Information
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NPI Number | 1063008589
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Entity Type | Individual
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Provider Name | KRISTIN KRYSIAK MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 2112 CASE PKWY STE 10
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City | TWINSBURG
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State | OH
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Zip | 44087-2378
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Country | US
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Telephone | 800-841-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 25101 GLENBROOK BLVD
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City | EUCLID
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State | OH
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Zip | 44117-1883
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Country | US
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Telephone | 216-990-0944
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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 | SP.13601
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License Number State | OH
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