Provider Demographics
NPI:1023362589
Name:DELGADO, KRYSTA NICOLE
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:NICOLE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 UNIVERSITY AVE W STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3435
Mailing Address - Country:US
Mailing Address - Phone:651-266-7999
Mailing Address - Fax:651-266-7850
Practice Address - Street 1:1919 UNIVERSITY AVE W STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3435
Practice Address - Country:US
Practice Address - Phone:651-266-7999
Practice Address - Fax:651-266-7850
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health