Doctor Name: | MRS. KRISTIN SWANSON POLK |
NPI Number: | 1710148366 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MACCC-SLP |
License Number: | 09142027 |
Business Practice Address: | 4120 Four Lakes Ave Linden, MI - 484519445 |
Business Phone Number: | 8106299334 |
Business Fax Number: | |
Mailing Address: | 4120 Four Lakes Ave, LINDEN |
State: | MI |
Postal Code: | 484519445 |
Phone Number: | 8106299334 |
Fax Number: | |
NPI Enumeration Date: | 06/17/2008 |
NPI Last Update Date: | 06/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 09142027 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
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 |