Provider Demographics
NPI:1700255536
Name:FAVRO, KRISTEN (MA, SLP-CCC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:FAVRO
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 WHITE BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1824
Mailing Address - Country:US
Mailing Address - Phone:513-226-4303
Mailing Address - Fax:
Practice Address - Street 1:1660 STERNBLOCK LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3805
Practice Address - Country:US
Practice Address - Phone:513-321-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist