Provider Demographics
NPI:1174760862
Name:HANCOCK, KRISTIN W (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:W
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5548
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-5548
Mailing Address - Country:US
Mailing Address - Phone:276-403-5882
Mailing Address - Fax:
Practice Address - Street 1:746 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4520
Practice Address - Country:US
Practice Address - Phone:764-035-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-6720Medicare PIN