Provider Demographics
NPI:1174988646
Name:RISPOLI, KRISTIN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MARIE
Last Name:RISPOLI
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 1:620 FARM LN
Mailing Address - Street 2:441 ERICKSON HALL
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1600
Mailing Address - Country:US
Mailing Address - Phone:517-432-9629
Mailing Address - Fax:
Practice Address - Street 1:300 N 5TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5504
Practice Address - Country:US
Practice Address - Phone:734-222-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016081103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist