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General NPI Number Information
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NPI Number | 1306369541
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Entity Type | Organization
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Legal Business Name | KIM RIST CONSULTING, INC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 1018 HUDSON AVENUE
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City | STILLWATER
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State | NY
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Zip | 12170
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Country | US
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Telephone | 518-573-1138
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Fax |
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Provider Business Mailing Address
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Address Line | 1018 HUDSON AVENUE
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City | STILLWATER
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State | NY
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Zip | 12170
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Country | US
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Telephone | 518-573-1138
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATION TEACHER
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Name | MRS. KIMBERLY J. RIST
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Credential | MSED, SPECIAL INSTRU
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Telephone | 518-573-1138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 120667489
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License Number State | NY
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