Basic Information
| Provider Information | |||||||||
| NPI: | 1679980429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOUISE | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 BRINKERHOFF ST | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129012703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185340222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 NEW YORK RD | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129033981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185613803 | ||||||||
| FaxNumber: | 5185613805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2014 | ||||||||
| LastUpdateDate: | 07/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | 1757917 | NY | Y | Other Service Providers | Health Educator |
ID Information
| ID | Type | State | Issuer | Description | 1757917 | 01 | NY | SPECIAL EDUCATION TEACHER | OTHER |