Provider Demographics
NPI:1114160504
Name:KALLEMEYN, KRISTEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:KALLEMEYN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 ROLLINS ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3720
Mailing Address - Country:US
Mailing Address - Phone:406-546-1707
Mailing Address - Fax:
Practice Address - Street 1:511 ROLLINS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3720
Practice Address - Country:US
Practice Address - Phone:406-546-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT861251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT861Medicaid