Provider Demographics
NPI:1366712598
Name:BARANIK, KRISTY JEAN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:JEAN
Last Name:BARANIK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:JEAN
Other - Last Name:SOBRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:41850 W 11 MILE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1857
Mailing Address - Country:US
Mailing Address - Phone:248-514-4474
Mailing Address - Fax:248-856-3105
Practice Address - Street 1:41850 W 11 MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1857
Practice Address - Country:US
Practice Address - Phone:248-514-4474
Practice Address - Fax:248-856-3105
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12146955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist