Carmen Elizabeth Krystofiak, MS SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

268204 Issued in KY

Practice address

1707 Cedar Grove Rd
Shepherdsville, KY 40165-8572

Phone

(502) 633-1007

NPI assigned

Dec 3, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1235734674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5512 HAMES TRCE APT 571",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402912067",
            "telephone_number": "502-269-2477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 CEDAR GROVE RD",
            "city": "SHEPHERDSVILLE",
            "state": "KY",
            "postal_code": "401658572",
            "telephone_number": "502-633-1007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5512 Hames Trce Apt 571",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402912067",
            "country_code": "US",
            "telephone_number": "502-269-2477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRYSTOFIAK",
        "first_name": "CARMEN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "MS SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-03",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "268204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Shepherdsville, KY
• Providers in Shepherdsville, KY by specialty
• Speech-Language Pathologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.