Basic Information
Provider Information | |||||||||
NPI: | 1164948931 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GIAMBRUNO | ||||||||
FirstName: | KRISTEN | ||||||||
MiddleName: | JEAN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 113 NANDINA TER | ||||||||
Address2: |   | ||||||||
City: | WINTER SPRINGS | ||||||||
State: | FL | ||||||||
PostalCode: | 327086184 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3219486869 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1000 W BROADWAY ST STE 214 | ||||||||
Address2: |   | ||||||||
City: | OVIEDO | ||||||||
State: | FL | ||||||||
PostalCode: | 327659262 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073595693 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/14/2017 | ||||||||
LastUpdateDate: | 09/18/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | SI2893 | FL | N |   | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 106S00000X |   |   | Y |   |   |   |   |
No ID Information.