Provider Demographics
NPI:1437670320
Name:MAKSEL, KIRSTY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KIRSTY
Middle Name:LYNN
Last Name:MAKSEL
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 1:250 BARTON DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-1704
Mailing Address - Country:US
Mailing Address - Phone:510-468-7180
Mailing Address - Fax:
Practice Address - Street 1:32145 ALVARADO NILES RD STE 201
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2930
Practice Address - Country:US
Practice Address - Phone:510-468-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist