Healthcare Provider Details

I. General information

NPI: 1346586054
Provider Name (Legal Business Name): ANGELINA ROSE KINN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 ACADEMY CIR STE 100
COLORADO SPRINGS CO
80909-1664
US

IV. Provider business mailing address

2105 ACADEMY CIR STE 100
COLORADO SPRINGS CO
80909-1664
US

V. Phone/Fax

Practice location:
  • Phone: 195-912-4637
  • Fax: 719-591-2484
Mailing address:
  • Phone: 195-912-4637
  • Fax: 719-591-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number690
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: