Provider Demographics
NPI:1932776960
Name:VISE, KYNDALL NICOLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KYNDALL
Middle Name:NICOLE
Last Name:VISE
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 1:4011 TALBOT RD S STE 210
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5791
Mailing Address - Country:US
Mailing Address - Phone:425-690-3602
Mailing Address - Fax:425-690-9602
Practice Address - Street 1:4011 TALBOT RD S STE 210
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5791
Practice Address - Country:US
Practice Address - Phone:425-690-3602
Practice Address - Fax:425-690-9602
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
WALD61504634231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist