Provider Demographics
NPI:1487648960
Name:BRONSON, KRISTI L (MS)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:BRONSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 E LINCOLN RD
Mailing Address - Street 2:#D323
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217
Mailing Address - Country:US
Mailing Address - Phone:509-868-1933
Mailing Address - Fax:
Practice Address - Street 1:1718 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-7775
Practice Address - Country:US
Practice Address - Phone:509-868-1933
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB40132Medicare ID - Type Unspecified