Provider Demographics
NPI:1568514743
Name:WASHBURN, KRISTEN D (MS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:D
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:D
Other - Last Name:BEECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 FORT WARREN AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-8269
Mailing Address - Country:US
Mailing Address - Phone:307-635-2617
Mailing Address - Fax:307-432-0531
Practice Address - Street 1:1401 AIRPORT PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1518
Practice Address - Country:US
Practice Address - Phone:307-635-0435
Practice Address - Fax:307-432-0531
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA976231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist