Provider Demographics
NPI:1922189737
Name:ROBERTS, KRISTINA (AUD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:ROBERTS
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 1:35 PEARL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2866
Mailing Address - Country:US
Mailing Address - Phone:781-769-3222
Mailing Address - Fax:781-255-9807
Practice Address - Street 1:35 PEARL ST STE 200
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2866
Practice Address - Country:US
Practice Address - Phone:508-588-8034
Practice Address - Fax:508-897-0475
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA567231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA448791OtherTUFTS-INDIVIDUAL
MA626538OtherHPHC AUDIOLOGY
MAAG0032OtherBCBS AUDIOLOGY GROUP
MA620733OtherTUFTS GROUP
MAAD0194OtherBCBS AUDIOLOGIST
MA626538OtherHPHC AUDIOLOGY
MARO-046764Medicare ID - Type UnspecifiedAUDIOLOGIST