Provider Demographics
NPI:1942653472
Name:KAFKA, KRISTI (EDS)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KAFKA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S MAIN AVE
Mailing Address - Street 2:PO BOX 238
Mailing Address - City:PLATTE
Mailing Address - State:SD
Mailing Address - Zip Code:57369-2117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:612 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369-2117
Practice Address - Country:US
Practice Address - Phone:605-337-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD68333-0103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool