Provider Demographics
NPI:1780181560
Name:KROGH, KRISTA (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:KROGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:SALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-IT
Mailing Address - Street 1:2108 63RD ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-4454
Mailing Address - Country:US
Mailing Address - Phone:262-652-2406
Mailing Address - Fax:262-652-2408
Practice Address - Street 1:2108 63RD ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-4454
Practice Address - Country:US
Practice Address - Phone:262-652-2406
Practice Address - Fax:262-652-2408
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7570-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor