Provider Demographics
NPI:1134993496
Name:KRYSTEN CHAMBERLAIN
Entity type:Organization
Organization Name:KRYSTEN CHAMBERLAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:586-944-1259
Mailing Address - Street 1:PO BOX 6583
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48608-6583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1038 GRANGER RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-9297
Practice Address - Country:US
Practice Address - Phone:989-941-6328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty