Provider Demographics
NPI:1679505887
Name:SULLIVAN, KRISTEN D (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:JEAN
Other - Last Name:DONCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 ALLDS ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-4711
Mailing Address - Country:US
Mailing Address - Phone:603-880-0090
Mailing Address - Fax:
Practice Address - Street 1:3 ALLDS ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4711
Practice Address - Country:US
Practice Address - Phone:603-880-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA639231H00000X
NHA4231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5103223Medicaid
MASU016064Medicare PIN