Provider Demographics
NPI:1619730900
Name:ACOSTA, KRISTIN DEANA (BS, CAADC-DP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DEANA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:BS, CAADC-DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 M 60 E
Mailing Address - Street 2:
Mailing Address - City:CASSOPOLIS
Mailing Address - State:MI
Mailing Address - Zip Code:49031-9339
Mailing Address - Country:US
Mailing Address - Phone:269-445-2451
Mailing Address - Fax:
Practice Address - Street 1:1124 AUSTIN
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-8310
Practice Address - Country:US
Practice Address - Phone:269-445-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator