Provider Demographics
NPI:1356981070
Name:GILL, KRISTE
Entity type:Individual
Prefix:
First Name:KRISTE
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WEST STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-4405
Mailing Address - Country:US
Mailing Address - Phone:860-613-9930
Mailing Address - Fax:
Practice Address - Street 1:321 FORTUNE BLVD # 202
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:860-613-9930
Practice Address - Fax:860-613-9952
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist