Provider Demographics
NPI:1003092602
Name:STONE, KRYSTAL GAIL (CSW)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:GAIL
Last Name:STONE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MS
Other - First Name:KRYSTAL
Other - Middle Name:GAIL
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:SUNRISE CHILDREN'S SERVICES
Mailing Address - Street 2:PO BOX 1429
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047
Mailing Address - Country:US
Mailing Address - Phone:502-538-1000
Mailing Address - Fax:502-538-1100
Practice Address - Street 1:2720 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-926-2484
Practice Address - Fax:270-685-6015
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
KYCSW6920104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker