MEDICARE: MRS. KRISTIN NICOLE LAIRD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist

General Provider Information

NPI Number	:	1174856009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN NICOLE LAIRD

Provider Business Mailing Address
First Line	:	PO BOX 191
Second Line	:
City	:	CRESCENT CITY
State	:	IL
Zip	:	60928-0191
Country	:	US
Telephone Number	:
Fax Number	:	708-777-6073

Provider Business Practice Location Address
First Line	:	503 E. MAIN ST.
Second Line	:
City	:	CRESCENT CITY
State	:	IL
Zip	:	60928-0191
Country	:	US
Telephone Number	:	815-210-2542
Fax Number	:	708-777-6073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/10/2009

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