MEDICARE: MRS. KRISTIN MARIE ITURBIDES 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
1	235Z00000X	Speech-Language Pathologist	41YS00542200	NJ

General Provider Information

NPI Number	:	1437279916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN MARIE ITURBIDES MS CCC-SLP

Provider Business Mailing Address
First Line	:	17 FAIRMOUNT TER
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5010
Country	:	US
Telephone Number	:	973-769-4399
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 FAIRMOUNT TER
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5010
Country	:	US
Telephone Number	:	973-769-4399
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	04/06/2016

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