Provider Demographics
NPI:1578129292
Name:KRIEG, COREY LLEWELLYN (SLP)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:LLEWELLYN
Last Name:KRIEG
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 COURTLAND DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8265
Mailing Address - Country:US
Mailing Address - Phone:616-401-6825
Mailing Address - Fax:
Practice Address - Street 1:8565 COURTLAND DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8265
Practice Address - Country:US
Practice Address - Phone:616-401-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician