Healthcare Provider Details

I. General information

NPI: 1417456021
Provider Name (Legal Business Name): KRISTEN CAROLINE HESS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD STE 234F
REDLANDS CA
92373-4775
US

IV. Provider business mailing address

101 E REDLANDS BLVD STE 234F
REDLANDS CA
92373-4775
US

V. Phone/Fax

Practice location:
  • Phone: 909-707-3073
  • Fax:
Mailing address:
  • Phone: 909-707-3073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number81607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81607
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: