Provider Demographics
NPI:1215414859
Name:DELWICHE, KRISTIN AMY (BS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:AMY
Last Name:DELWICHE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 WIDE HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5081
Mailing Address - Country:US
Mailing Address - Phone:530-721-0953
Mailing Address - Fax:
Practice Address - Street 1:2349 WIDE HORIZON DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5081
Practice Address - Country:US
Practice Address - Phone:530-721-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician