Provider Demographics
NPI:1902130065
Name:FRADUA, KRISTIN ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:ANN
Last Name:FRADUA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1801
Mailing Address - Country:US
Mailing Address - Phone:516-661-2252
Mailing Address - Fax:
Practice Address - Street 1:2 BEACH RD
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1801
Practice Address - Country:US
Practice Address - Phone:516-661-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019542-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist