Healthcare Provider Details

I. General information

NPI: 1760096366
Provider Name (Legal Business Name): JESSICA KREIDLER AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 ARLINGTON BLVD STE 302
FAIRFAX VA
22031-2902
US

IV. Provider business mailing address

8301 ARLINGTON BLVD STE 302
FAIRFAX VA
22031-2902
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-1123
  • Fax: 703-645-0793
Mailing address:
  • Phone: 703-204-1123
  • Fax: 703-645-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001795
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: