Basic Information
| Provider Information | |||||||||
| NPI: | 1568504967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIES | ||||||||
| FirstName: | KRISTIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 FRANTZ RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430166102 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 931 CHATHAM LN STE 201 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432212417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145335000 | ||||||||
| FaxNumber: | 6145330103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 10/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | P07621 | OH | N | Behavioral Health & Social Service Providers | Psychologist | 103G00000X | P07621 | OH | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.