Provider Demographics
NPI:1831501105
Name:KISTHARDT, ALLISON (MS)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KISTHARDT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 RIVERSIDE DR
Mailing Address - Street 2:APT 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1030
Mailing Address - Country:US
Mailing Address - Phone:917-656-0640
Mailing Address - Fax:
Practice Address - Street 1:760 RIVERSIDE DRIVE
Practice Address - Street 2:APT 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031
Practice Address - Country:US
Practice Address - Phone:917-656-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist