Provider Demographics
NPI:1295066900
Name:DRAEGER, KRISTIN ANNE (RN,LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ANNE
Last Name:DRAEGER
Suffix:
Gender:F
Credentials:RN,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 IRONGATE WALK
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2820
Mailing Address - Country:US
Mailing Address - Phone:636-207-0377
Mailing Address - Fax:
Practice Address - Street 1:924 IRONGATE WALK
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2820
Practice Address - Country:US
Practice Address - Phone:636-207-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090364951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical