Provider Demographics
NPI:1942229240
Name:IDEN, KRISTIN DARLENE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DARLENE
Last Name:IDEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:DARLENE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1540 SPRING VALLEY DRIVE
Mailing Address - Street 2:AUDIOLOGY (126)
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704
Mailing Address - Country:US
Mailing Address - Phone:304-429-6741
Mailing Address - Fax:304-429-0263
Practice Address - Street 1:1540 SPRING VALLEY DRIVE
Practice Address - Street 2:AUDIOLOGY (126)
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:304-429-0263
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0365231H00000X
KYKY-0365231HA2400X, 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