Provider Demographics
NPI:1801861588
Name:MCBRIDE, INGRID KRISTINA (AUD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:KRISTINA
Last Name:MCBRIDE
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 1:7353 E SAYAN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1821
Mailing Address - Country:US
Mailing Address - Phone:480-965-0614
Mailing Address - Fax:480-965-0076
Practice Address - Street 1:7353 E SAYAN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-1821
Practice Address - Country:US
Practice Address - Phone:602-578-9541
Practice Address - Fax:480-218-4362
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA829231HA2400X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS81746Medicare ID - Type Unspecified