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General NPI Number Information
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NPI Number | 1356531123
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Entity Type | Individual
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Provider Name | KRISTEN DEANNE FLUGSTAD PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 15 E CHERRY AVE
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4699
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Country | US
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Telephone | 928-380-0181
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Fax |
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Provider Business Mailing Address
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Address Line | 99 SHOSHONE ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-9528
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Country | US
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Telephone | 928-380-0181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3509
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License Number State | AZ
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