Provider Demographics
NPI:1477711562
Name:EIDAM, KRISTIN LINNEA (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LINNEA
Last Name:EIDAM
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3566
Mailing Address - Country:US
Mailing Address - Phone:401-782-4400
Mailing Address - Fax:401-782-4994
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3566
Practice Address - Country:US
Practice Address - Phone:401-782-4400
Practice Address - Fax:401-782-4994
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00176231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6490065561Medicare PIN