Provider Demographics
NPI:1942520440
Name:RHEA, KRISTINA MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:RHEA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N OHIO ST
Mailing Address - Street 2:
Mailing Address - City:CAMP POINT
Mailing Address - State:IL
Mailing Address - Zip Code:62320-1133
Mailing Address - Country:US
Mailing Address - Phone:217-257-9032
Mailing Address - Fax:
Practice Address - Street 1:220 N OHIO ST
Practice Address - Street 2:
Practice Address - City:CAMP POINT
Practice Address - State:IL
Practice Address - Zip Code:62320-1133
Practice Address - Country:US
Practice Address - Phone:217-257-9032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist