Provider Demographics
NPI:1053994608
Name:NEWBY, KRISTINA ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:NEWBY
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 1:479 FAIRVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-2914
Mailing Address - Country:US
Mailing Address - Phone:307-705-2878
Mailing Address - Fax:
Practice Address - Street 1:479 FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-2914
Practice Address - Country:US
Practice Address - Phone:307-705-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-1102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist