Provider Demographics
NPI:1417544362
Name:SADDLER, KRISTIN SKEESICK
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SKEESICK
Last Name:SADDLER
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 1:10371 LORENA DR
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72932-9492
Mailing Address - Country:US
Mailing Address - Phone:318-518-2517
Mailing Address - Fax:
Practice Address - Street 1:1955 W TRUCKERS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5637
Practice Address - Country:US
Practice Address - Phone:479-973-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9161101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor