Provider Demographics
NPI:1477113843
Name:DRESBACH, KRISTEN ELISE (MSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELISE
Last Name:DRESBACH
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 1:1017 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3486
Mailing Address - Country:US
Mailing Address - Phone:630-864-8075
Mailing Address - Fax:
Practice Address - Street 1:194 E SOUTHWAY BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3650
Practice Address - Country:US
Practice Address - Phone:765-450-4843
Practice Address - Fax:765-450-4895
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker