Provider Demographics
NPI:1568448793
Name:SHEEHAN, KRISTINA M (MA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:M
Other - Last Name:WINANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:9604 COLDWATER RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2096
Mailing Address - Country:US
Mailing Address - Phone:260-479-7844
Mailing Address - Fax:260-444-3656
Practice Address - Street 1:9604 COLDWATER RD
Practice Address - Street 2:SUITE 109
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2096
Practice Address - Country:US
Practice Address - Phone:260-479-7844
Practice Address - Fax:260-444-3656
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002234A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200447930Medicaid
IN200447930Medicaid