Provider Demographics
NPI:1487988333
Name:TEASDALE, KRISTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:TEASDALE
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 1:4223 W 73RD TER
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3510 CLINTON PL
Practice Address - Street 2:SUITE 320
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2195
Practice Address - Country:US
Practice Address - Phone:785-843-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1829103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling