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General NPI Number Information
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NPI Number | 1417117466
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Entity Type | Individual
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Provider Name | KRISTEN A HEALY CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 505 SAN MARIN DR STE 100B
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City | NOVATO
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State | CA
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Zip | 94945-1309
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Country | US
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Telephone | 908-868-5380
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Fax |
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Provider Business Mailing Address
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Address Line | 217 QUINCY AVE APT 2
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City | LONG BEACH
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State | CA
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Zip | 90803-1631
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Country | US
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Telephone | 908-868-5380
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12152573
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License Number State | CA
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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 | 41YS00519500
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License Number State | NJ
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