Basic Information
| Provider Information | |||||||||
| NPI: | 1982005831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAYTON | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A.,CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41555 COOK ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922115184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608370033 | ||||||||
| FaxNumber: | 7608371013 | ||||||||
| Practice Location | |||||||||
| Address1: | 41555 COOK ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922115184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608370033 | ||||||||
| FaxNumber: | 7608371013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 05/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 14513 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 14513 | 01 | CA | SPEECH LANGUAGE AND HEARING | OTHER |