Provider Demographics
NPI:1073525663
Name:KONRAD, KRISTINE KELLY (MS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KELLY
Last Name:KONRAD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 SAINT FRANCIS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-8433
Mailing Address - Country:US
Mailing Address - Phone:920-434-7053
Mailing Address - Fax:
Practice Address - Street 1:421 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2249
Practice Address - Country:US
Practice Address - Phone:920-746-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health