Provider Demographics
NPI:1699809608
Name:MANSFIELD, KRISTINE JEANNE (AUD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:JEANNE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 4TH ST APT 169
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2134
Mailing Address - Country:US
Mailing Address - Phone:631-730-1987
Mailing Address - Fax:
Practice Address - Street 1:119 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2018
Practice Address - Country:US
Practice Address - Phone:631-475-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001978231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist