Provider Demographics
NPI:1386860617
Name:JUERGENS, KRISTIN ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ANN
Last Name:JUERGENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9120 W HAMPTON AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4960
Mailing Address - Country:US
Mailing Address - Phone:262-391-8040
Mailing Address - Fax:262-780-0992
Practice Address - Street 1:9120 W HAMPTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4960
Practice Address - Country:US
Practice Address - Phone:262-391-8040
Practice Address - Fax:262-780-0992
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2761-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical