Provider Demographics
NPI:1497130884
Name:KIRSCH, CARSON LYNETTE (AUD)
Entity Type:Individual
Prefix:DR
First Name:CARSON
Middle Name:LYNETTE
Last Name:KIRSCH
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 1:2730 WILSHIRE BLVD
Mailing Address - Street 2:STE 450
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4742
Mailing Address - Country:US
Mailing Address - Phone:310-207-1526
Mailing Address - Fax:
Practice Address - Street 1:1919 SANTA MONICA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1966
Practice Address - Country:US
Practice Address - Phone:310-207-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2113231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist