Provider Demographics
NPI:1366853442
Name:KROON, KARIE KAY
Entity Type:Individual
Prefix:
First Name:KARIE
Middle Name:KAY
Last Name:KROON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 LONDON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2422
Mailing Address - Country:US
Mailing Address - Phone:218-393-5407
Mailing Address - Fax:218-461-3666
Practice Address - Street 1:1420 LONDON RD STE 204
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2422
Practice Address - Country:US
Practice Address - Phone:218-393-5407
Practice Address - Fax:218-461-3666
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical