1659402659 NPI number — KRISTINA M WARING CCC-SLP

Table of content: KRISTINA M WARING CCC-SLP (NPI 1659402659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659402659 NPI number — KRISTINA M WARING CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARING
Provider First Name:
KRISTINA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659402659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6200 GOLDEN WOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99516-5015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-529-0332
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5660 B ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99518-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-205-4751
Provider Business Practice Location Address Fax Number:
907-802-4520
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  160 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 2207616 . This is a "DBA WARING WELLNESS AK BUSINESS LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 09147660 . This is a "ASHA CERTIFICATION" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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