Provider Demographics
NPI:1639426612
Name:BROOKS, KRISTEN RUMBAUGH (MSED)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RUMBAUGH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 CARMAN RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5424
Mailing Address - Country:US
Mailing Address - Phone:518-357-0095
Mailing Address - Fax:
Practice Address - Street 1:3437 CARMAN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5424
Practice Address - Country:US
Practice Address - Phone:518-357-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist