Provider Demographics
NPI:1295426393
Name:SPRICK, KRISTIN MICHELLE (CLINICAL SUPERVISOR)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:SPRICK
Suffix:
Gender:F
Credentials:CLINICAL SUPERVISOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 LEARNING LN
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-4533
Mailing Address - Country:US
Mailing Address - Phone:651-360-3202
Mailing Address - Fax:
Practice Address - Street 1:4911 LEARNING LN
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-4533
Practice Address - Country:US
Practice Address - Phone:651-360-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician