Provider Demographics
NPI:1407660590
Name:HAMMARGREN, KRISTINE MARIE
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:HAMMARGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HUMBOLDT WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2958
Mailing Address - Country:US
Mailing Address - Phone:907-347-7142
Mailing Address - Fax:
Practice Address - Street 1:102 10TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5003
Practice Address - Country:US
Practice Address - Phone:907-759-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK234056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist