Provider Demographics
NPI:1699967976
Name:PETERS, KRISTIN JOAN FLYNN (PHD)
Entity type:Individual
Prefix:
First Name:KRISTIN JOAN
Middle Name:FLYNN
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:JOAN
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:315 BUSINESS LOOP 70 W
Practice Address - Street 2:HOWARD A. RUSK REHABILITATION CENTER, HEALTH PSYCHOLOGY
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3248
Practice Address - Country:US
Practice Address - Phone:573-882-8876
Practice Address - Fax:573-884-3518
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009031637103TC0700X
IL071006055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical