Provider Demographics
NPI:1265497796
Name:LEWIS, KRISTEN L (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:4200 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-6913
Mailing Address - Country:US
Mailing Address - Phone:816-932-1660
Mailing Address - Fax:816-932-1675
Practice Address - Street 1:4200 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-6913
Practice Address - Country:US
Practice Address - Phone:816-932-1660
Practice Address - Fax:816-932-1675
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003003229231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200252410AMedicaid
MO338309909Medicaid
MOP92380Medicare UPIN
MO609C516Medicare ID - Type UnspecifiedAUDIOLOGY