Provider Demographics
NPI:1386043206
Name:GREEN, KRYSTA (AUD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SUNNYSIDE AVE
Mailing Address - Street 2:2101 HAWORTH HALL
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7600
Mailing Address - Country:US
Mailing Address - Phone:785-864-0656
Mailing Address - Fax:
Practice Address - Street 1:1200 SUNNYSIDE AVE
Practice Address - Street 2:2101 HAWORTH HALL
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7600
Practice Address - Country:US
Practice Address - Phone:785-864-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2258231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist