Provider Demographics
NPI:1871149773
Name:KORSAK, KRISTINA (AUD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KORSAK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:211 S JAMESTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-8814
Mailing Address - Country:US
Mailing Address - Phone:316-655-2812
Mailing Address - Fax:
Practice Address - Street 1:1301 W 12TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2588
Practice Address - Country:US
Practice Address - Phone:620-340-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2376231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist