Provider Demographics
NPI:1467749036
Name:WEINBAUM, KRISTEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:WEINBAUM
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 1:4331 S HWY 27
Mailing Address - Street 2:SUITE A5
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5349
Mailing Address - Country:US
Mailing Address - Phone:352-227-1474
Mailing Address - Fax:352-989-4923
Practice Address - Street 1:4331 S HWY 27
Practice Address - Street 2:SUITE A5
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5349
Practice Address - Country:US
Practice Address - Phone:352-227-1474
Practice Address - Fax:352-989-4923
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1691231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist