Provider Demographics
NPI:1063222842
Name:HEDGE, KRYSTAL ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:ANN
Last Name:HEDGE
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 1:30 ADMINISTRATION RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3230
Mailing Address - Country:US
Mailing Address - Phone:508-279-1000
Mailing Address - Fax:
Practice Address - Street 1:30 ADMINISTRATION RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3230
Practice Address - Country:US
Practice Address - Phone:508-279-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical