Provider Demographics
NPI:1053895086
Name:CONKLIN, KRISTEN (MA, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 W JERICHO TPKE STE 1C
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3214
Mailing Address - Country:US
Mailing Address - Phone:631-806-5250
Mailing Address - Fax:
Practice Address - Street 1:823 W JERICHO TPKE STE 1C
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3214
Practice Address - Country:US
Practice Address - Phone:631-806-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist