Provider Demographics
NPI:1750424271
Name:HUIZDOS, KRISTEN MARIE (AUD,CCC-A)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:HUIZDOS
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 1:6650 HIGHLAND RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1660
Mailing Address - Country:US
Mailing Address - Phone:248-886-0110
Mailing Address - Fax:248-886-0194
Practice Address - Street 1:6650 HIGHLAND RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1660
Practice Address - Country:US
Practice Address - Phone:248-886-0110
Practice Address - Fax:248-886-0194
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000411231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter