Provider Demographics
NPI:1730547308
Name:WESTPHAL, KRISTIN COPELAND
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:COPELAND
Last Name:WESTPHAL
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 1:10340 PLEASANT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3947
Mailing Address - Country:US
Mailing Address - Phone:317-776-9000
Mailing Address - Fax:
Practice Address - Street 1:10340 PLEASANT ST STE 100
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3947
Practice Address - Country:US
Practice Address - Phone:317-776-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006251A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist