Basic Information
| Provider Information | |||||||||
| NPI: | 1336784024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 CASWELL AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028405808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015236428 | ||||||||
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| Practice Location | |||||||||
| Address1: | 76 ACCORD PARK DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819230900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2019 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP01319 | RI | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 9815 | MA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.