Provider Demographics
NPI:1912218389
Name:HALE, KRISTIN D (AUD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:D
Last Name:HALE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 5TH STREET HOLLOW RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-7757
Mailing Address - Country:US
Mailing Address - Phone:570-784-8050
Mailing Address - Fax:570-784-8058
Practice Address - Street 1:2201 5TH STREET HOLLOW RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-7757
Practice Address - Country:US
Practice Address - Phone:570-784-8050
Practice Address - Fax:570-784-8058
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006167231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist