Provider Demographics
NPI:1538983630
Name:KEMM, KRISTINA (BA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KEMM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16894 E 104TH AVE UNIT D211
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-9918
Mailing Address - Country:US
Mailing Address - Phone:303-704-2176
Mailing Address - Fax:
Practice Address - Street 1:10190 MONTVIEW BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-2202
Practice Address - Country:US
Practice Address - Phone:303-704-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician