Provider Demographics
NPI:1174856009
Name:LAIRD, KRISTIN NICOLE
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:LAIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60928-0191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:708-777-6073
Practice Address - Street 1:503 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:IL
Practice Address - Zip Code:60928-0191
Practice Address - Country:US
Practice Address - Phone:815-210-2542
Practice Address - Fax:708-777-6073
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist