Provider Demographics
NPI:1245832625
Name:PARKS, KRISTEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4347 W NORTHWEST HWY # 130-342
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-3864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9407 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-3850
Practice Address - Country:US
Practice Address - Phone:214-353-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113685OtherTEXAS LICENSE FOR SPEECH-LANGUAGE PATHOLOGISTS
TX14072175OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION CERTIFICATION