Provider Demographics
NPI:1689284069
Name:FERNANDEZ, KRISTEN SKONBERG (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:SKONBERG
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:ALEXA
Other - Last Name:SKONBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:506 SUGARLAND RUN DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-1176
Mailing Address - Country:US
Mailing Address - Phone:202-841-2852
Mailing Address - Fax:
Practice Address - Street 1:506 SUGARLAND RUN DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-1176
Practice Address - Country:US
Practice Address - Phone:202-841-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7936235Z00000X
VA2202009628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist