Individual
KRISTIN PACHECO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1415 W DAKOTA PKWY, WILLISTON, ND 58801-3885
(701) 572-6757
(401) 774-3532
Mailing address
PO BOX 1097, WATFORD CITY, ND 58854-1097
(701) 444-5221
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
855
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55201
—
ND
01
—
855
STATE LICENSE
ND
Enumeration date
04/16/2008
Last updated
04/16/2008
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