Provider Demographics
NPI:1063106342
Name:BOUTIN, KRISTIN JO
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JO
Last Name:BOUTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3507
Mailing Address - Country:US
Mailing Address - Phone:402-705-1864
Mailing Address - Fax:
Practice Address - Street 1:2317 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3507
Practice Address - Country:US
Practice Address - Phone:402-705-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician