Provider Demographics
NPI:1821973330
Name:KUDERA, KRISTAN ANN (BS IN PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:ANN
Last Name:KUDERA
Suffix:
Gender:F
Credentials:BS IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1645
Mailing Address - Country:US
Mailing Address - Phone:208-514-2500
Mailing Address - Fax:
Practice Address - Street 1:8610 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1645
Practice Address - Country:US
Practice Address - Phone:208-514-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical