Provider Demographics
NPI:1528232329
Name:PARKINS, KRISTINE MARY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARY
Last Name:PARKINS
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 1:2004 HIGHLAND AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4400
Mailing Address - Country:US
Mailing Address - Phone:715-835-5915
Mailing Address - Fax:715-835-8112
Practice Address - Street 1:2004 HIGHLAND AVE
Practice Address - Street 2:SUITE M
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4400
Practice Address - Country:US
Practice Address - Phone:715-835-5915
Practice Address - Fax:715-835-8112
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3817-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528232329Medicaid