Provider Demographics
NPI:1629258165
Name:RICE ERSO, KRISTINA LUELLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LUELLA
Last Name:RICE ERSO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LUELLA
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15110 S VALLEY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:VALLEYFORD
Mailing Address - State:WA
Mailing Address - Zip Code:99036-9768
Mailing Address - Country:US
Mailing Address - Phone:509-714-2662
Mailing Address - Fax:
Practice Address - Street 1:15110 S VALLEY CHAPEL RD
Practice Address - Street 2:
Practice Address - City:VALLEYFORD
Practice Address - State:WA
Practice Address - Zip Code:99036-9768
Practice Address - Country:US
Practice Address - Phone:509-714-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004387103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical