Provider Demographics
NPI:1245261486
Name:BISH, KRISTEN MARIA (AUD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARIA
Last Name:BISH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:MARIA
Other - Last Name:DASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 51025
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-1025
Mailing Address - Country:US
Mailing Address - Phone:843-364-6361
Mailing Address - Fax:843-285-5921
Practice Address - Street 1:9730 DORCHESTER RD UNIT 206
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9034
Practice Address - Country:US
Practice Address - Phone:843-594-3032
Practice Address - Fax:843-285-5921
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3192231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0728Medicaid
SCSA0728Medicaid