Provider Demographics
NPI:1821277526
Name:PAASCH, KRISTI LYNN
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:PAASCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1355
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-1355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 ORANGE ST
Practice Address - Street 2:SUITE E
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3242
Practice Address - Country:US
Practice Address - Phone:951-660-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 241251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical