Provider Demographics
NPI:1003239153
Name:FASSETT, KRISTINA (MA)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:FASSETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6562 WESTON CIR E
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9442
Mailing Address - Country:US
Mailing Address - Phone:614-873-5727
Mailing Address - Fax:
Practice Address - Street 1:6562 WESTON CIR E
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9442
Practice Address - Country:US
Practice Address - Phone:614-873-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01554231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist