Provider Demographics
NPI:1477622553
Name:SANDS, KRISTEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:SANDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8221
Mailing Address - Country:US
Mailing Address - Phone:314-251-4683
Mailing Address - Fax:314-251-4380
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-4683
Practice Address - Fax:314-251-4380
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01911103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499328102Medicaid
MOP00859253OtherRAILROAD MEDICARE
MO1477622553Medicaid
MOP00859253OtherRAILROAD MEDICARE
MO499328102Medicaid