Provider Demographics
NPI:1386756690
Name:VRIESWYK, KRISTIN (AUD, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:VRIESWYK
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 CHATTANOOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2637
Mailing Address - Country:US
Mailing Address - Phone:706-279-3277
Mailing Address - Fax:706-272-4137
Practice Address - Street 1:1436 CHATTANOOGA AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2637
Practice Address - Country:US
Practice Address - Phone:706-279-3277
Practice Address - Fax:706-272-4137
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA1393237600000X, 231H00000X
GAAUD003669231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter