Provider Demographics
NPI:1568689081
Name:KRISH, GENEVA A (MS CCCA)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:A
Last Name:KRISH
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CORRALES ROAD SUITE I
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:505-890-0003
Mailing Address - Fax:505-890-3330
Practice Address - Street 1:10700 CORRALES ROAD SUITE I
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-890-0003
Practice Address - Fax:505-890-3330
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3857237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59524065Medicaid