MEDICARE: KRISTEN MARIE KILMER MS, CCC-SLP/TSSLD

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
1	235Z00000X	Speech-Language Pathologist	028901-01	NY

General Provider Information

NPI Number	:	1407491988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARIE KILMER MS, CCC-SLP/TSSLD

Provider Business Mailing Address
First Line	:	211 RINGGOLD ST
Second Line	:
City	:	PEEKSKILL
State	:	NY
Zip	:	10566-3308
Country	:	US
Telephone Number	:	845-661-9778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 STONY ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1913
Country	:	US
Telephone Number	:	914-885-1995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	11/08/2019

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Directions to “ KRISTEN MARIE KILMER MS, CCC-SLP/TSSLD” Practice Location

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