Provider Demographics
NPI:1639602238
Name:BADGER, KRISTIE ELLEN
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:ELLEN
Last Name:BADGER
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 1:2225 CHALLENGER WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5400
Mailing Address - Country:US
Mailing Address - Phone:707-565-4970
Mailing Address - Fax:707-565-5183
Practice Address - Street 1:2225 CHALLENGER WAY STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5400
Practice Address - Country:US
Practice Address - Phone:707-565-4970
Practice Address - Fax:707-565-5183
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor