Provider Demographics
NPI:1811624919
Name:HERDE, KRISTEN KATHLEEN (CTRS)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:KATHLEEN
Last Name:HERDE
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CROWN COLONY CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7144
Mailing Address - Country:US
Mailing Address - Phone:914-714-4157
Mailing Address - Fax:
Practice Address - Street 1:100 CROWN COLONY CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7144
Practice Address - Country:US
Practice Address - Phone:914-714-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist