Provider Demographics
NPI:1760076558
Name:HIESTAND, KRISTA JEAN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:JEAN
Last Name:HIESTAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2063
Mailing Address - Country:US
Mailing Address - Phone:913-648-4500
Mailing Address - Fax:
Practice Address - Street 1:3501 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66206-2063
Practice Address - Country:US
Practice Address - Phone:913-648-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist