Provider Demographics
NPI:1619146743
Name:LONG, KRISTA DENISE (MSW LISW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:DENISE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:DENISE
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:601 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2501
Mailing Address - Country:US
Mailing Address - Phone:515-237-5023
Mailing Address - Fax:515-237-5099
Practice Address - Street 1:601 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2501
Practice Address - Country:US
Practice Address - Phone:515-991-2485
Practice Address - Fax:515-237-5099
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469676Medicaid