Provider Demographics
NPI:1407879893
Name:BREITAG, KRISTIN JANET (MSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:JANET
Last Name:BREITAG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 S MELANIE LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4269
Mailing Address - Country:US
Mailing Address - Phone:605-371-0004
Mailing Address - Fax:605-333-6878
Practice Address - Street 1:2501 W 22ND ST
Practice Address - Street 2:VAMC
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1305
Practice Address - Country:US
Practice Address - Phone:605-333-6861
Practice Address - Fax:605-333-6878
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker