Provider Demographics
NPI:1174297147
Name:JEFFRIES, KRISTEN (CDCA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 N CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1110
Mailing Address - Country:US
Mailing Address - Phone:330-397-8745
Mailing Address - Fax:
Practice Address - Street 1:1051 N CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1110
Practice Address - Country:US
Practice Address - Phone:330-397-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst