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General NPI Number Information
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NPI Number | 1639229867
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Entity Type | Individual
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Provider Name | KRISTIN LILLIE AUD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 2611 PRINGLE RD SE
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City | SALEM
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State | OR
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Zip | 97302-1533
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Country | US
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Telephone | 503-588-5330
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Fax | 503-540-4473
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Provider Business Mailing Address
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Address Line | 2743 FAIRWAY ST
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City | WOODBURN
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State | OR
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Zip | 97071-7706
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Country | US
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Telephone | 503-982-0261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 22536
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License Number State | OR
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