Provider Demographics
NPI:1891118733
Name:GILBERT, KRISTEN (BS, RSST, QMRP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:BS, RSST, QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31738 RUSH ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1758
Mailing Address - Country:US
Mailing Address - Phone:734-377-1753
Mailing Address - Fax:734-427-3327
Practice Address - Street 1:31738 RUSH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1758
Practice Address - Country:US
Practice Address - Phone:734-377-1753
Practice Address - Fax:734-427-3327
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2393359104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker