Provider Demographics
NPI:1619559408
Name:MIEDECKE, KRISTI LEIGH
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:LEIGH
Last Name:MIEDECKE
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 1:31857 RED PINE WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4133
Mailing Address - Country:US
Mailing Address - Phone:619-994-1823
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 108
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2646
Practice Address - Country:US
Practice Address - Phone:951-900-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist