Provider Demographics
NPI:1275902801
Name:WESSNER, KRYSTIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTIN
Middle Name:
Last Name:WESSNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 KITELINE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3805
Mailing Address - Country:US
Mailing Address - Phone:509-654-5710
Mailing Address - Fax:
Practice Address - Street 1:4785 DORSEY HALL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7728
Practice Address - Country:US
Practice Address - Phone:410-531-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05642103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical