Provider Demographics
NPI:1699333963
Name:WALDING, KRISTIN DANIELLE (BC-HIS)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DANIELLE
Last Name:WALDING
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:D
Other - Last Name:WALDING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:3703 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1448
Mailing Address - Country:US
Mailing Address - Phone:334-803-4404
Mailing Address - Fax:
Practice Address - Street 1:112 HAVEN DR STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2908
Practice Address - Country:US
Practice Address - Phone:334-793-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4173237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist