Provider Demographics
NPI:1831405422
Name:CRISHON, AMANDA N (AUD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:CRISHON
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 1:1115 RONALD REAGAN PKWY
Mailing Address - Street 2:STE 225
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6910
Mailing Address - Country:US
Mailing Address - Phone:317-844-7059
Mailing Address - Fax:317-819-0044
Practice Address - Street 1:1115 RONALD REAGAN PKWY
Practice Address - Street 2:STE 225
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6910
Practice Address - Country:US
Practice Address - Phone:317-844-7059
Practice Address - Fax:317-819-0044
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002480A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist