Provider Demographics
NPI:1558583518
Name:ANGERHOFER, KRISTAN ALLISSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTAN
Middle Name:ALLISSA
Last Name:ANGERHOFER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8904 OLIVE LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4438
Mailing Address - Country:US
Mailing Address - Phone:612-240-6309
Mailing Address - Fax:763-515-2442
Practice Address - Street 1:8904 OLIVE LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4438
Practice Address - Country:US
Practice Address - Phone:612-240-6309
Practice Address - Fax:763-515-2442
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist