Provider Demographics
NPI:1295456432
Name:KRIETEMEYER, KINDRA NOELLE (LCSW)
Entity type:Individual
Prefix:
First Name:KINDRA
Middle Name:NOELLE
Last Name:KRIETEMEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 COUNTY ROAD 307
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MO
Mailing Address - Zip Code:63471-2021
Mailing Address - Country:US
Mailing Address - Phone:573-279-5880
Mailing Address - Fax:
Practice Address - Street 1:428 COUNTY ROAD 307
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MO
Practice Address - Zip Code:63471-2021
Practice Address - Country:US
Practice Address - Phone:573-279-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
20230047541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker