Basic Information
Provider Information | |||||||||
NPI: | 1467778522 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HASSLER | ||||||||
FirstName: | KRISTINE | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SHANOFF | ||||||||
OtherFirstName: | KRISTI | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5526 N ACADEMY BLVD STE 109 | ||||||||
Address2: |   | ||||||||
City: | COLORADO SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 809183688 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7193015100 | ||||||||
FaxNumber: | 7199602649 | ||||||||
Practice Location | |||||||||
Address1: | 5526 N ACADEMY BLVD STE 109 | ||||||||
Address2: |   | ||||||||
City: | COLORADO SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 809183688 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7193015100 | ||||||||
FaxNumber: | 7199602649 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/14/2010 | ||||||||
LastUpdateDate: | 03/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225C00000X |   |   | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |   | 103K00000X | 11416520 | CO | Y |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   |
ID Information
ID | Type | State | Issuer | Description | 1-14-16520 | 01 |   | BEHAVIOR ANALYST CERTIFICATION BOARD | OTHER |