Provider Demographics
NPI:1003397100
Name:ORMSON, KRISTIAN TAGE
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:TAGE
Last Name:ORMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4130
Mailing Address - Country:US
Mailing Address - Phone:806-468-4343
Mailing Address - Fax:806-468-4366
Practice Address - Street 1:5501 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4130
Practice Address - Country:US
Practice Address - Phone:806-468-4343
Practice Address - Fax:806-468-4366
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80618231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist