Provider Demographics
NPI:1902072184
Name:GUNNELS, KRISTA EATON (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:EATON
Last Name:GUNNELS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:LEIGH
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4448 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1216
Mailing Address - Country:US
Mailing Address - Phone:407-513-3000
Mailing Address - Fax:407-515-6519
Practice Address - Street 1:4448 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1216
Practice Address - Country:US
Practice Address - Phone:407-513-3000
Practice Address - Fax:407-515-6519
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist