Provider Demographics
NPI:1396039749
Name:FRICK, KRISTA LAUREN BROULLIRE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:LAUREN BROULLIRE
Last Name:FRICK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:LAUREN
Other - Last Name:BROULLIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14600 KING RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7952
Mailing Address - Country:US
Mailing Address - Phone:734-486-4444
Mailing Address - Fax:734-486-5555
Practice Address - Street 1:14600 KING RD
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7952
Practice Address - Country:US
Practice Address - Phone:734-486-4444
Practice Address - Fax:734-486-5555
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000576237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter