Provider Demographics
NPI:1730360876
Name:KISTLER, LINDA ROSE (MA ATR-BC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ROSE
Last Name:KISTLER
Suffix:
Gender:F
Credentials:MA ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6280
Mailing Address - Country:US
Mailing Address - Phone:570-455-1521
Mailing Address - Fax:
Practice Address - Street 1:214 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6280
Practice Address - Country:US
Practice Address - Phone:570-455-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004750101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor