Provider Demographics
NPI:1093148710
Name:BREKELMANS, KRISTIN R (BS, CADC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:BREKELMANS
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9640 SE 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:RUNNELLS
Mailing Address - State:IA
Mailing Address - Zip Code:50237-1054
Mailing Address - Country:US
Mailing Address - Phone:515-802-1650
Mailing Address - Fax:
Practice Address - Street 1:9640 SE 40TH AVE
Practice Address - Street 2:
Practice Address - City:RUNNELLS
Practice Address - State:IA
Practice Address - Zip Code:50237-1054
Practice Address - Country:US
Practice Address - Phone:515-802-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14103101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)