Provider Demographics
NPI:1083195655
Name:GULSETH, KRISTAN
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:
Last Name:GULSETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTAN
Other - Middle Name:
Other - Last Name:EASLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 STATE ST STE 750
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5861
Mailing Address - Country:US
Mailing Address - Phone:971-273-7502
Mailing Address - Fax:
Practice Address - Street 1:3400 STATE ST STE 750
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5861
Practice Address - Country:US
Practice Address - Phone:971-273-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst