Provider Demographics
NPI:1649976291
Name:SCHEIDEL, KRISTEN LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:SCHEIDEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYNN
Other - Last Name:MALLOURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21390 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9122
Mailing Address - Country:US
Mailing Address - Phone:248-931-9919
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:734-845-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010984161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical