Provider Demographics
NPI:1558545954
Name:EBSEN, KRISTI K (MSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:K
Last Name:EBSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:
Other - Last Name:EBSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:220 OAK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4407
Mailing Address - Country:US
Mailing Address - Phone:734-223-6014
Mailing Address - Fax:
Practice Address - Street 1:220 OAK MEADOW DR
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4407
Practice Address - Country:US
Practice Address - Phone:734-223-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010859141041C0700X
CALCSW1175211041C0700X
NY096616-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6664OtherMEDICARE GROUP
MIMI6664001OtherMEDICARE