Provider Demographics
NPI:1326120585
Name:ASHWELL, KRISTEN MARIE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:ASHWELL
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 1:9801 DUPONT AVE S
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3100
Mailing Address - Country:US
Mailing Address - Phone:952-567-6092
Mailing Address - Fax:952-567-6176
Practice Address - Street 1:9801 DUPONT AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3100
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-884-2656
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7080231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4500533OtherMEDICA CHOICE
382G5ASOtherBLUE CROSS BLUE SHIELD
HP57804OtherHEALTH PARTNERS
MN278321500Medicaid
4500121OtherDUAL SOLUTION
640000304Medicare ID - Type UnspecifiedMEDICARE