Provider Demographics
NPI:1720464829
Name:HENDRIX, KRISTA
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 N PALOMINO DR W
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-8929
Mailing Address - Country:US
Mailing Address - Phone:812-887-8168
Mailing Address - Fax:
Practice Address - Street 1:607 DUBOIS ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1048
Practice Address - Country:US
Practice Address - Phone:812-886-3460
Practice Address - Fax:812-473-0763
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23002575A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist