Provider Demographics
NPI:1760097216
Name:KREISLE, ALICE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:KREISLE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KINGSFORD ELEMENTARY SCHOOL
Mailing Address - Street 2:1401 ENTERPRISE ROAD
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2215
Mailing Address - Country:US
Mailing Address - Phone:301-390-0260
Mailing Address - Fax:
Practice Address - Street 1:KINGSFORD ELEMENTARY SCHOOL
Practice Address - Street 2:1401 ENTERPRISE ROAD
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-2215
Practice Address - Country:US
Practice Address - Phone:301-390-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01157231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist