Basic Information
| Provider Information | |||||||||
| NPI: | 1740424951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITSER | ||||||||
| FirstName: | KRISTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 406153 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303841876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614788770 | ||||||||
| FaxNumber: | 5615987231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 S CENTER RD | ||||||||
| Address2: | BLDG. A | ||||||||
| City: | BURTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485091731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107438470 | ||||||||
| FaxNumber: | 8107438699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2009 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | MI | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.