Provider Demographics
NPI:1265461123
Name:UNGERLEIDER, KRISTA KAY (MSSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:KAY
Last Name:UNGERLEIDER
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8249 S 42ND ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-7811
Mailing Address - Country:US
Mailing Address - Phone:414-421-2240
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER-5000 W NATIONAL AVE
Practice Address - Street 2:DOMICILIARY BUILDING 43
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-902-5430
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6847-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical