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General NPI Number Information
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NPI Number | 1669731279
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Entity Type | Individual
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Provider Name | KRISTEN LEIGH MARDIS SLP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 2401 OLIVER RD
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City | MONROE
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State | LA
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Zip | 71201-2934
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Country | US
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Telephone | 318-381-8520
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Fax |
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Provider Business Mailing Address
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Address Line | 2015 FRANCES PL
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City | MONROE
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State | LA
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Zip | 71201-2707
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Country | US
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Telephone | 318-614-7549
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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 | 6626
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License Number State | LA
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