Provider Demographics
NPI:1245642719
Name:KISTLER, KATRINA (MA)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:KISTLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 WINDROW DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4163
Mailing Address - Country:US
Mailing Address - Phone:717-391-6720
Mailing Address - Fax:
Practice Address - Street 1:1829 WINDROW DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4163
Practice Address - Country:US
Practice Address - Phone:717-391-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002136103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst