Provider Demographics
NPI:1508106493
Name:MARKAN, KRISTEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTEEN
Middle Name:
Last Name:MARKAN
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 1:418 W. KALAMAZOO AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007
Mailing Address - Country:US
Mailing Address - Phone:269-553-7120
Mailing Address - Fax:269-553-7129
Practice Address - Street 1:418 W. KALAMAZOO AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-553-7120
Practice Address - Fax:269-553-7129
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILLMSW104100000X
CAACSW104100000X
MI6801102059104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker