Provider Demographics
NPI:1275411597
Name:STANISLAV, KRISTEN (EDS)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:STANISLAV
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 S 216TH ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-4729
Mailing Address - Country:US
Mailing Address - Phone:402-332-3265
Mailing Address - Fax:
Practice Address - Street 1:11717 S 216TH ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4729
Practice Address - Country:US
Practice Address - Phone:402-332-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20240005278103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool