Basic Information
| Provider Information | |||||||||
| NPI: | 1790896561 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSS | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | LAYNE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MCSD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FOSS-STONE | ||||||||
| OtherFirstName: | KRISTY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MCSD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 35100 | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591075100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062382500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 801 N 29TH ST | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591010905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062382500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 10/19/2011 | ||||||||
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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 | 231H00000X | Y | Speech, Language and Hearing Service Providers | Audiologist | 231HA2400X | 602 | MT | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231HA2500X | 602 | MT | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | 237600000X | 602 | MT | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 116552600 | 01 | WY | MDCD PIN | OTHER | 0531148 | 01 | MT | MDCD PIN | OTHER | 000029148 | 01 | MT | BCBS PIN | OTHER | 0531148 | 05 | MT | MEDICAID |