Provider Demographics
NPI:1326050196
Name:DEPOUW, KRISTIN R (AUD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:DEPOUW
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:R
Other - Last Name:NEHRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2845 GREENBRIER RD STE 220
Mailing Address - Street 2:PO BOX 8900
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54308-8900
Mailing Address - Country:US
Mailing Address - Phone:920-288-8230
Mailing Address - Fax:920-288-8235
Practice Address - Street 1:2845 GREENBRIER RD STE 220
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-8230
Practice Address - Fax:920-288-8235
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI385231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41141700Medicaid
WI018807650Medicare ID - Type Unspecified
Q01993Medicare UPIN