Provider Demographics
NPI:1952523953
Name:HEDBERG, KRISTIN (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HEDBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KEA
Other - Middle Name:
Other - Last Name:HEDBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:343 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2603
Mailing Address - Country:US
Mailing Address - Phone:831-247-7355
Mailing Address - Fax:
Practice Address - Street 1:108 LOCUST ST STE 4
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3934
Practice Address - Country:US
Practice Address - Phone:831-247-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9839171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist