Provider Demographics
NPI:1083966519
Name:DRASKOVIC, KRISTEN (LCSW, RN, RDN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DRASKOVIC
Suffix:
Gender:F
Credentials:LCSW, RN, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 BUCHANAN AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-0913
Mailing Address - Country:US
Mailing Address - Phone:701-866-2612
Mailing Address - Fax:
Practice Address - Street 1:4590 HARRISON BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3350
Practice Address - Country:US
Practice Address - Phone:701-866-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11601167-3102163WP0808X
UT11601167-35011041C0700X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered