Individual
KRISTEN ALICE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
21585 PEABODY ST, LEONARDTOWN, MD 20650-2955
(301) 475-8000
Mailing address
4 ELENA CT, MEDFORD, NJ 08055-9175
(609) 760-3921
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
09410
MD
Other
Enumeration date
03/14/2018
Last updated
06/23/2020
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