Provider Demographics
NPI:1487010682
Name:GREENWALD, KRISTEN KELLY (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:KELLY
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 HORIZON DR STE 225
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DR STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-0000
Practice Address - Country:US
Practice Address - Phone:970-668-3478
Practice Address - Fax:970-668-0632
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COLSW.0009922051104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health