Individual
KIRSTEN N STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2214 E FAIRVIEW AVE, JOHNSON CITY, TN 37601-2860
(423) 928-6464
(423) 232-7970
Mailing address
PO BOX 191, JOHNSON CITY, TN 37605-0191
(423) 928-6464
(423) 232-7970
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202009802
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202009802
VIRGINIA LICENSE
VA
01
—
7397
TENNESSEE LICENSE
TN
Enumeration date
01/12/2021
Last updated
02/19/2021
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