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Individual

KRISTINA MUSTACICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CCC-SLP

Contact information

Practice address
2500 NE 65TH AVE, VANCOUVER, WA 98661-6812
(360) 750-7500
Mailing address
6474 SPERRY RD, MOUNT HOOD PARKDALE, OR 97041-7640
(503) 780-9390

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
15299
OR
235Z00000X
Speech-Language Pathologist
Primary
LL 60490718
WA

Other

Enumeration date
11/24/2014
Last updated
11/24/2014
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