Basic Information
| Provider Information | |||||||||
| NPI: | 1699173880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUMRALL | ||||||||
| FirstName: | KRISTI | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3195 CALDER ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098334115 | ||||||||
| FaxNumber: | 4098331626 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 IH 10 N | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777072544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098350228 | ||||||||
| FaxNumber: | 4098350151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2014 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 103861 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.