Provider Demographics
NPI:1376724385
Name:DECELLES, KRISTEN HERRMANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:HERRMANN
Last Name:DECELLES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:H
Other - Last Name:DECELLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:43309 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-6221
Mailing Address - Country:US
Mailing Address - Phone:800-282-9905
Mailing Address - Fax:
Practice Address - Street 1:43309 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-6221
Practice Address - Country:US
Practice Address - Phone:800-282-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1310231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist