Individual
MS. KIRSTEN LEE PROUTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
807 WILBRAHAM RD, SPRINGFIELD, MA 01109-2067
(607) 437-0761
Mailing address
975 POWERS RD, CONKLIN, NY 13748-1315
(607) 437-0761
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
07193
MD
235Z00000X
Speech-Language Pathologist
19238
CA
235Z00000X
Speech-Language Pathologist
Primary
9018
MA
235Z00000X
Speech-Language Pathologist
SL011372
PA
Other
Enumeration date
06/05/2013
Last updated
10/31/2017
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