MEDICARE: KRISTEN LEE DESJARDINS M.S., 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	105140	TX

General Provider Information

NPI Number	:	1609215300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LEE DESJARDINS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	8610 SOUTHWESTERN BLVD
Second Line	:	APT 1502
City	:	DALLAS
State	:	TX
Zip	:	75206-2600
Country	:	US
Telephone Number	:	512-970-8714
Fax Number	:

Provider Business Practice Location Address
First Line	:	8610 SOUTHWESTERN BLVD
Second Line	:	APT 1502
City	:	DALLAS
State	:	TX
Zip	:	75206-2600
Country	:	US
Telephone Number	:	512-970-8714
Fax Number	:

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	06/21/2013

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Directions to “ KRISTEN LEE DESJARDINS M.S., CCC-SLP” Practice Location

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