Provider Demographics
NPI:1265766828
Name:WALDEN, KRISTINA K (AUD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:K
Last Name:WALDEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 W CLINCH AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2219
Mailing Address - Country:US
Mailing Address - Phone:865-521-6005
Mailing Address - Fax:865-521-6088
Practice Address - Street 1:2100 W CLINCH AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2219
Practice Address - Country:US
Practice Address - Phone:865-521-6005
Practice Address - Fax:865-521-6088
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51767231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist