Provider Demographics
NPI:1174927693
Name:KREISCHER, CHRISSY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISSY
Middle Name:
Last Name:KREISCHER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 WOLFCALE RD
Mailing Address - Street 2:
Mailing Address - City:CONVOY
Mailing Address - State:OH
Mailing Address - Zip Code:45832-9042
Mailing Address - Country:US
Mailing Address - Phone:419-203-7194
Mailing Address - Fax:
Practice Address - Street 1:1120 BUCKEYE DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2655
Practice Address - Country:US
Practice Address - Phone:419-238-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 11358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist