Provider Demographics
NPI:1124655915
Name:OUELLETTE, KRISTY M (BC-HIS)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:M
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 LIGHT ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4658
Mailing Address - Country:US
Mailing Address - Phone:203-395-3578
Mailing Address - Fax:
Practice Address - Street 1:240 INDIAN RIVER RD STE A4
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3690
Practice Address - Country:US
Practice Address - Phone:203-795-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000435237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist