=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285223669
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN REDA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2021
-----------------------------------------------------
Last Update Date | 10/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20421 ROUTE 19 STE 310
-----------------------------------------------------
City | CRANBERRY TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16066-7517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-709-4667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20397 ROUTE 19 STE 130
-----------------------------------------------------
City | CRANBERRY TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16066-6133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-709-4667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC014938
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------