Provider Demographics
NPI:1508505173
Name:STEIN, KRISTINA ELIZABETH (MSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ELIZABETH
Last Name:STEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:861 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1717
Mailing Address - Country:US
Mailing Address - Phone:801-603-2823
Mailing Address - Fax:
Practice Address - Street 1:49 E 200 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1047
Practice Address - Country:US
Practice Address - Phone:801-779-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12810570-35061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical