Provider Demographics
NPI:1144733684
Name:MUNRO, KRISTIE MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:MUNRO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:GALLAGHER
Other - Last Name:MUNRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4000 FLOWERING STREAM WAY
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-8663
Mailing Address - Country:US
Mailing Address - Phone:410-935-1214
Mailing Address - Fax:
Practice Address - Street 1:4000 FLOWERING STREAM WAY
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32766-8663
Practice Address - Country:US
Practice Address - Phone:410-935-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist