Provider Demographics
NPI:1639976798
Name:SOUDERS, KRISTA F
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:F
Last Name:SOUDERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:F
Other - Last Name:BUNGENSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5630 BRIDGETOWN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-4346
Mailing Address - Country:US
Mailing Address - Phone:513-939-0300
Mailing Address - Fax:
Practice Address - Street 1:5630 BRIDGETOWN RD STE 4
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-4346
Practice Address - Country:US
Practice Address - Phone:513-939-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical