Provider Demographics
NPI:1124375431
Name:KRYGIEL, TRACI KIM (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:KIM
Last Name:KRYGIEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ERIN RD
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-7319
Mailing Address - Country:US
Mailing Address - Phone:573-259-2301
Mailing Address - Fax:
Practice Address - Street 1:13160 CR 3610
Practice Address - Street 2:
Practice Address - City:ST. JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-1089
Practice Address - Country:US
Practice Address - Phone:573-259-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012021690104100000X
MO20150357801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker