Healthcare Provider Details

I. General information

NPI: 1639229867
Provider Name (Legal Business Name): KRISTIN LILLIE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN ANDERLE MS

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 PRINGLE RD SE
SALEM OR
97302-1533
US

IV. Provider business mailing address

2743 FAIRWAY ST
WOODBURN OR
97071-7706
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5330
  • Fax: 503-540-4473
Mailing address:
  • Phone: 503-982-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number22536
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: