Provider Demographics
NPI:1255663142
Name:ERIE, KRISTIN GILDSETH (MSSW, LGSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:GILDSETH
Last Name:ERIE
Suffix:
Gender:F
Credentials:MSSW, LGSW
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:GILDSETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-1188
Mailing Address - Country:US
Mailing Address - Phone:218-749-2881
Mailing Address - Fax:218-749-3806
Practice Address - Street 1:624 13TH ST S
Practice Address - Street 2:RANGE MENTAL HEALTHCENTER
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3149
Practice Address - Country:US
Practice Address - Phone:218-749-2881
Practice Address - Fax:218-749-3806
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLGSW10854104100000X
MN108541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker