Provider Demographics
NPI:1629822820
Name:SCARDINA, KRISTINE
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:SCARDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:EUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6247
Mailing Address - Country:US
Mailing Address - Phone:262-470-9580
Mailing Address - Fax:
Practice Address - Street 1:309 E NORTH ST
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3718
Practice Address - Country:US
Practice Address - Phone:262-408-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8727-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional