Provider Demographics
NPI:1619125531
Name:FRIEHE, KRISTIN JOY (AUD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:JOY
Last Name:FRIEHE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:JOY
Other - Last Name:GROENENBOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:16909 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-4220
Mailing Address - Country:US
Mailing Address - Phone:402-326-3240
Mailing Address - Fax:
Practice Address - Street 1:16909 PALISADES DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-4220
Practice Address - Country:US
Practice Address - Phone:402-326-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355A2700X, 231H00000X, 237700000X
NE116237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025771100Medicaid