Healthcare Provider Details

I. General information

NPI: 1407379696
Provider Name (Legal Business Name): KRISTIN MAURA ALESHIRE AUD, MA-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 BARTFIELD DR
COLUMBUS OH
43207-4153
US

IV. Provider business mailing address

775 BARTFIELD DR
COLUMBUS OH
43207-4153
US

V. Phone/Fax

Practice location:
  • Phone: 740-704-6892
  • Fax:
Mailing address:
  • Phone: 740-704-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.01916
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20211706-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: