Provider Demographics
NPI:1033242516
Name:SCOTT, KRISTINA L (LPCC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:L
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1707 MILLER TRUNK HWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1880
Mailing Address - Country:US
Mailing Address - Phone:218-729-6480
Mailing Address - Fax:
Practice Address - Street 1:1707 MILLER TRUNK HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1880
Practice Address - Country:US
Practice Address - Phone:218-729-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4918101YP2500X
MN1225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional