Provider Demographics
NPI:1770607855
Name:FAUTH, KRISTIN ASHLEY (BA)
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:ASHLEY
Last Name:FAUTH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1300 S CATALINA AVE
Mailing Address - Street 2:APT 215
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21707 HAWTHORNE BLVD
Practice Address - Street 2:STE 300
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7009
Practice Address - Country:US
Practice Address - Phone:310-543-9900
Practice Address - Fax:310-543-9910
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker