Provider Demographics
NPI:1558618306
Name:WUNDERMAN, KRISTINA FOSTER
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:FOSTER
Last Name:WUNDERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 APPALACHIAN DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2504
Mailing Address - Country:US
Mailing Address - Phone:925-954-7620
Mailing Address - Fax:
Practice Address - Street 1:272 APPALACHIAN DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-954-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health