Provider Demographics
NPI:1972041317
Name:CONKLE, KRYSTAL A (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:A
Last Name:CONKLE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-3941
Mailing Address - Country:US
Mailing Address - Phone:608-728-0957
Mailing Address - Fax:
Practice Address - Street 1:32 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3941
Practice Address - Country:US
Practice Address - Phone:608-618-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130523-121104100000X
WI9087-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9087-123OtherMENTAL HEALTH