Provider Demographics
NPI:1952980906
Name:EISENMANN, KIRSTIE (MS)
Entity Type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:
Last Name:EISENMANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 DON LUIS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-4216
Mailing Address - Country:US
Mailing Address - Phone:310-614-7305
Mailing Address - Fax:
Practice Address - Street 1:2551 N ROUND VALLEY RD
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-7611
Practice Address - Country:US
Practice Address - Phone:310-614-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist