Basic Information
| Provider Information | |||||||||
| NPI: | 1538355979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | KIERSTEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 824 MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194604478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104151100 | ||||||||
| FaxNumber: | 6104151101 | ||||||||
| Practice Location | |||||||||
| Address1: | 7691 5 MILE RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452304348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134215558 | ||||||||
| FaxNumber: | 5136325804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | AT005920 | PA | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.