Provider Demographics
NPI:1881943280
Name:JAUCH, KRISTIN LAURA
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LAURA
Last Name:JAUCH
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 1:2 SAPLING CIRCLE #16
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:720-308-5158
Mailing Address - Fax:
Practice Address - Street 1:30 PRINCETON BLVD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851
Practice Address - Country:US
Practice Address - Phone:978-454-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist