Provider Demographics
NPI:1124566112
Name:WURTH, KRISTEN ELIZABETH (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:WURTH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1665 SAVANNAH CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3681
Mailing Address - Country:US
Mailing Address - Phone:517-914-1868
Mailing Address - Fax:
Practice Address - Street 1:1665 SAVANNAH CT
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3681
Practice Address - Country:US
Practice Address - Phone:517-914-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010988811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical