Provider Demographics
NPI:1659662815
Name:KIEROD, KRYSTAL ESTELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:ESTELLE
Last Name:KIEROD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MYSTIC LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1942
Mailing Address - Country:US
Mailing Address - Phone:215-203-2044
Mailing Address - Fax:
Practice Address - Street 1:20 MYSTIC LN STE A
Practice Address - Street 2:MORNING STAR LIFE SERVICES, LLC
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1942
Practice Address - Country:US
Practice Address - Phone:215-203-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016974103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist