Individual
MR. ETHAN KRISTEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
1600 S HICKORY ST, MOUNT VERNON, MO 65712-2045
(417) 466-7103
Mailing address
309 W SEMINOLE ST, SPRINGFIELD, MO 65807-2959
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2016020591
MO
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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