Basic Information
| Provider Information | |||||||||
| NPI: | 1912289190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATH | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | THERESA | ||||||||
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| Credential: | M.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1689 AUBURN RD | ||||||||
| Address2: | |||||||||
| City: | WANTAGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117933512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164263023 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15050 14TH RD | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113572609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187670091 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2011 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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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 | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 270904637 | 01 | NY | ALL IN ONE SPOT SPEECH LANGUAGE PATHOLOGY | OTHER |