Provider Demographics
NPI:1750035291
Name:CHARTRAND, KRISTINA (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:CHARTRAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3588
Mailing Address - Country:US
Mailing Address - Phone:913-416-0744
Mailing Address - Fax:
Practice Address - Street 1:820 JUSTIN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3588
Practice Address - Country:US
Practice Address - Phone:913-416-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS124251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical