Provider Demographics
NPI:1285528224
Name:FENNELL, KRISTA LEANA (MSPED)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEANA
Last Name:FENNELL
Suffix:
Gender:F
Credentials:MSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 STEPHENS BLVD
Mailing Address - Street 2:
Mailing Address - City:NYSSA
Mailing Address - State:OR
Mailing Address - Zip Code:97913-5473
Mailing Address - Country:US
Mailing Address - Phone:208-880-4065
Mailing Address - Fax:
Practice Address - Street 1:727 STEPHENS BLVD
Practice Address - Street 2:
Practice Address - City:NYSSA
Practice Address - State:OR
Practice Address - Zip Code:97913-5473
Practice Address - Country:US
Practice Address - Phone:208-880-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician