Provider Demographics
NPI:1902973332
Name:BEAN, KRISTY LYNN (SLP SPEED LANGUAGE P)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LYNN
Last Name:BEAN
Suffix:
Gender:F
Credentials:SLP SPEED LANGUAGE P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 19TH ST #4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1948
Mailing Address - Country:US
Mailing Address - Phone:310-828-3369
Mailing Address - Fax:310-828-3369
Practice Address - Street 1:2300 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91807
Practice Address - Country:US
Practice Address - Phone:626-281-8441
Practice Address - Fax:626-289-5376
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist