Healthcare Provider Details

I. General information

NPI: 1144565342
Provider Name (Legal Business Name): KRISTEN VERCHICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2432 CERRILLOS RD
SANTA FE NM
87505-3392
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE 300N
CLACKAMAS OR
97015-5703
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-1066
  • Fax: 505-424-4263
Mailing address:
  • Phone: 612-351-1529
  • Fax: 952-915-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: