Healthcare Provider Details

I. General information

NPI: 1235346206
Provider Name (Legal Business Name): CRISTY SACKETT ED. M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NORSEMAN AVE NW
LAKE PLACID FL
33852
US

IV. Provider business mailing address

102 NORSEMAN AVE NW
LAKE PLACID FL
33852
US

V. Phone/Fax

Practice location:
  • Phone: 217-799-0658
  • Fax:
Mailing address:
  • Phone: 217-799-0658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: