Provider Demographics
NPI:1649692047
Name:MITAL, KRISTIN (MS -SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MITAL
Suffix:
Gender:F
Credentials:MS -SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 W STONEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3172
Mailing Address - Country:US
Mailing Address - Phone:630-554-6156
Mailing Address - Fax:
Practice Address - Street 1:933 W STONEHEDGE DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3172
Practice Address - Country:US
Practice Address - Phone:630-965-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist