Basic Information
| Provider Information | |||||||||
| NPI: | 1295924397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLOWAY | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 MDG/SGHJ | ||||||||
| Address2: | 4881 SUGAR MAPLE DRIVE | ||||||||
| City: | WRIGHT PATTERSON AFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372576529 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 88 MDG/SGHJ | ||||||||
| Address2: | 4881 SUGAR MAPLE DR | ||||||||
| City: | WRIGHT-PATTERSON AFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372571942 | ||||||||
| FaxNumber: | 9376561347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2007 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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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 | 7025 | OH | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.