Provider Demographics
NPI:1932838059
Name:HAEBERLEIN, KRISTEN ALICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ALICIA
Last Name:HAEBERLEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1463
Mailing Address - Country:US
Mailing Address - Phone:502-741-5975
Mailing Address - Fax:
Practice Address - Street 1:12680 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6289
Practice Address - Country:US
Practice Address - Phone:314-872-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021030105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical