Provider Demographics
NPI:1588220164
Name:VANDERPOOL, KRISTIN J
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:VANDERPOOL
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 1:526 POINSETTIA AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4549
Mailing Address - Country:US
Mailing Address - Phone:352-220-1002
Mailing Address - Fax:
Practice Address - Street 1:526 POINSETTIA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4549
Practice Address - Country:US
Practice Address - Phone:352-220-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician