Provider Demographics
NPI:1851693816
Name:WEIRES, KRISTINE ANN (LCSW-PIP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ANN
Last Name:WEIRES
Suffix:
Gender:F
Credentials:LCSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 S WESTERN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5040
Mailing Address - Country:US
Mailing Address - Phone:605-361-0114
Mailing Address - Fax:605-332-1723
Practice Address - Street 1:5201 S WESTERN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5040
Practice Address - Country:US
Practice Address - Phone:605-361-0114
Practice Address - Fax:605-332-1723
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD22451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical