Provider Demographics
NPI:1902164924
Name:LANDAS, KRISTINA B (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:B
Last Name:LANDAS
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 1:209 ELDEN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4852
Mailing Address - Country:US
Mailing Address - Phone:703-435-0488
Mailing Address - Fax:
Practice Address - Street 1:209 ELDEN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4852
Practice Address - Country:US
Practice Address - Phone:703-435-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist