Provider Demographics
NPI:1831140631
Name:HAYES, KRISTEN D (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:HAYES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:D
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 ROLLINS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2376
Mailing Address - Country:US
Mailing Address - Phone:573-449-5999
Mailing Address - Fax:
Practice Address - Street 1:1411 ROLLINS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2376
Practice Address - Country:US
Practice Address - Phone:573-449-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0012941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496829417Medicaid
MO14187456OtherCAQH
MO800006982OtherRR MEDICARE