Provider Demographics
NPI:1215733134
Name:GARDNER, KRISTIN (M ED)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:GARDNER
Suffix:
Gender:
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 N 12TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1225
Mailing Address - Country:US
Mailing Address - Phone:717-412-0245
Mailing Address - Fax:
Practice Address - Street 1:635 N 12TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1225
Practice Address - Country:US
Practice Address - Phone:717-412-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor