Provider Demographics
NPI:1841399698
Name:JUETTE, KRISTI L (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:JUETTE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:L
Other - Last Name:HERST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 S COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1873
Mailing Address - Country:US
Mailing Address - Phone:509-765-0674
Mailing Address - Fax:509-765-6591
Practice Address - Street 1:605 S COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1873
Practice Address - Country:US
Practice Address - Phone:509-765-0674
Practice Address - Fax:509-765-6591
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00047286101Y00000X
WALW60111389171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor