Provider Demographics
NPI:1851097430
Name:BRUMMUND, KRISTINA JO (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JO
Last Name:BRUMMUND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 PREMIER DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6991
Mailing Address - Country:US
Mailing Address - Phone:507-479-7267
Mailing Address - Fax:
Practice Address - Street 1:1961 PREMIER DR STE 220
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6991
Practice Address - Country:US
Practice Address - Phone:507-479-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN212861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical