Provider Demographics
NPI:1437677242
Name:SOTO, KRISSY SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISSY
Middle Name:SUE
Last Name:SOTO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ROLLA ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-8001
Mailing Address - Country:US
Mailing Address - Phone:425-387-2832
Mailing Address - Fax:
Practice Address - Street 1:1000 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2634
Practice Address - Country:US
Practice Address - Phone:573-774-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2017031532104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker