Provider Demographics
NPI:1578100483
Name:KRIEG, ZACHARY (LBSW)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:KRIEG
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 47TH AVE S APT 337
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3627
Mailing Address - Country:US
Mailing Address - Phone:701-318-5294
Mailing Address - Fax:
Practice Address - Street 1:151 S 4TH ST STE 401
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4715
Practice Address - Country:US
Practice Address - Phone:701-757-3000
Practice Address - Fax:701-795-3127
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5710104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker