Provider Demographics
NPI:1184421802
Name:VANDERHOOF, KRISTAN DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:DIANE
Last Name:VANDERHOOF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 PIGEON ROOST RD
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:KY
Mailing Address - Zip Code:41168-8132
Mailing Address - Country:US
Mailing Address - Phone:606-928-6648
Mailing Address - Fax:606-928-1056
Practice Address - Street 1:2901 PIGEON ROOST RD
Practice Address - Street 2:
Practice Address - City:RUSH
Practice Address - State:KY
Practice Address - Zip Code:41168-8132
Practice Address - Country:US
Practice Address - Phone:606-928-6648
Practice Address - Fax:606-928-1056
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260068104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker