Provider Demographics
NPI:1134479975
Name:BOVE, KRYSTLE HANNA (AUD)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:HANNA
Last Name:BOVE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 BEAVERKILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2359
Mailing Address - Country:US
Mailing Address - Phone:410-313-7046
Mailing Address - Fax:410-313-7049
Practice Address - Street 1:5451 BEAVERKILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2359
Practice Address - Country:US
Practice Address - Phone:410-313-7046
Practice Address - Fax:410-313-7049
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001492231H00000X
MD01257231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist