Provider Demographics
NPI:1467019893
Name:RICCIONI, KRISTA LINNE (MA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LINNE
Last Name:RICCIONI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1418
Mailing Address - Country:US
Mailing Address - Phone:207-449-3809
Mailing Address - Fax:
Practice Address - Street 1:44 ELM ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1418
Practice Address - Country:US
Practice Address - Phone:207-449-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP531231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist