Healthcare Provider Details

I. General information

NPI: 1972250629
Provider Name (Legal Business Name): KRISTY RISEDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 E INDIANA AVE STE 30400
SPOKANE VALLEY WA
99216-2830
US

IV. Provider business mailing address

12707 E MANSFIELD AVE APT B206
SPOKANE VALLEY WA
99216-7007
US

V. Phone/Fax

Practice location:
  • Phone: 509-900-3669
  • Fax:
Mailing address:
  • Phone: 571-361-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberLABA.AB.7012417
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: