Provider Demographics
NPI:1528003456
Name:KRISTJANSON, JODI M (LAC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:KRISTJANSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21372
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104
Mailing Address - Country:US
Mailing Address - Phone:406-294-9606
Mailing Address - Fax:406-294-9607
Practice Address - Street 1:2116 BROADWATER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-294-9606
Practice Address - Fax:406-294-9607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1145101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)