Provider Demographics
NPI:1962655720
Name:HELM, KRISTIN MEREDITH (LISW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MEREDITH
Last Name:HELM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 N B ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2971
Mailing Address - Country:US
Mailing Address - Phone:641-454-5054
Mailing Address - Fax:
Practice Address - Street 1:402 N B ST STE 104
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2971
Practice Address - Country:US
Practice Address - Phone:641-454-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007213104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1023232824Medicaid
IAI53960018Medicare PIN