Provider Demographics
NPI:1598144487
Name:DEHRKOOP, KRISTIN LEE
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LEE
Last Name:DEHRKOOP
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:LEE
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISCSW
Mailing Address - Street 1:1833 E WELCO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1733
Mailing Address - Country:US
Mailing Address - Phone:507-380-7946
Mailing Address - Fax:
Practice Address - Street 1:1833 E WELCO DR
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1733
Practice Address - Country:US
Practice Address - Phone:507-380-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical