Healthcare Provider Details

I. General information

NPI: 1063586907
Provider Name (Legal Business Name): KRISTIE A IACUESSA AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE A DION M.A., CCC-A

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 MAIN ST
YARMOUTH ME
04096-6720
US

IV. Provider business mailing address

163 MAIN ST
YARMOUTH ME
04096-6720
US

V. Phone/Fax

Practice location:
  • Phone: 207-846-1380
  • Fax: 207-846-9701
Mailing address:
  • Phone: 207-846-1380
  • Fax: 207-846-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAP1251, DL20000389
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: