Doctor Name: | KRISTA BETH IACOBUCCI |
NPI Number: | 1306040688 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SP00726 |
Business Practice Address: | 642 Metacom Ave Warren, RI - 028852350 |
Business Phone Number: | 4012452860 |
Business Fax Number: | |
Mailing Address: | 289 River Ave, PROVIDENCE |
State: | RI |
Postal Code: | 029084248 |
Phone Number: | 4012779441 |
Fax Number: | |
NPI Enumeration Date: | 06/12/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP00726 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |