Provider Demographics
NPI:1134434756
Name:FUNK SCHLIESTETT, KRISTINA (MED, BCBA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:FUNK SCHLIESTETT
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903
Mailing Address - Country:US
Mailing Address - Phone:207-752-2709
Mailing Address - Fax:888-882-6306
Practice Address - Street 1:978 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1855
Practice Address - Country:US
Practice Address - Phone:207-752-2709
Practice Address - Fax:888-882-6306
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-09-5668103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst