Provider Demographics
NPI:1780820597
Name:THACKER, KRISTIE J (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:J
Last Name:THACKER
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:J
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCA-A
Mailing Address - Street 1:1735 27TH ST
Mailing Address - Street 2:WALLER BUILDING, SUITE B06
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2677
Mailing Address - Country:US
Mailing Address - Phone:740-356-8008
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1711 27TH ST
Practice Address - Street 2:BRAUNLIN BUILDING, SUITE 403
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2654
Practice Address - Country:US
Practice Address - Phone:740-353-7881
Practice Address - Fax:740-355-8594
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01284231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist