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NPI Code Detail

MEDICARE: MRS. KRISTINE ARCHER MS-CCC-SLP

MEDICARE: MRS. KRISTINE ARCHER MS-CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist04400MD

General Provider Information

NPI Number : 1306965918
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTINE ARCHER MS-CCC-SLP
Provider Business Mailing Address
First Line : 3 DEVON CT
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21403-1651
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 35 MILKSHAKE LN
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21403-1507
Country : US
Telephone Number : 410-269-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. KRISTINE ARCHER MS-CCC-SLP” Practice Location

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