Provider Demographics
NPI:1235475641
Name:MOESNER, KRISTIN LEIGH
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LEIGH
Last Name:MOESNER
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 1:8759 N STATE ROAD 161
Mailing Address - Street 2:
Mailing Address - City:GENTRYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47537-7816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4900 SHAMROCK DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7325
Practice Address - Country:US
Practice Address - Phone:812-479-7737
Practice Address - Fax:812-479-7737
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005183A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist