Provider Demographics
NPI:1629061429
Name:HENGSTENBERG, KATE CREIGHTON (MA CCCA SP)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:CREIGHTON
Last Name:HENGSTENBERG
Suffix:
Gender:F
Credentials:MA CCCA SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3038
Mailing Address - Country:US
Mailing Address - Phone:505-623-8474
Mailing Address - Fax:505-623-8220
Practice Address - Street 1:1000 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3038
Practice Address - Country:US
Practice Address - Phone:505-623-8474
Practice Address - Fax:505-623-8220
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3717237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
3717Medicare UPIN