Provider Demographics
NPI:1366488629
Name:ALTHOUSE, KRISLYN (SLP)
Entity Type:Individual
Prefix:
First Name:KRISLYN
Middle Name:
Last Name:ALTHOUSE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISLYN
Other - Middle Name:J
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/CCC-SLP
Mailing Address - Street 1:1931 ROAD 323
Mailing Address - Street 2:
Mailing Address - City:SARONVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:68975-9764
Mailing Address - Country:US
Mailing Address - Phone:402-984-8404
Mailing Address - Fax:402-412-4296
Practice Address - Street 1:1931 ROAD 323
Practice Address - Street 2:
Practice Address - City:SARONVILLE
Practice Address - State:NE
Practice Address - Zip Code:68975-9764
Practice Address - Country:US
Practice Address - Phone:402-984-8404
Practice Address - Fax:402-412-4296
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1670235Z00000X
NE0244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist