Provider Demographics
NPI:1700134434
Name:SARGENT, KRISTINA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:MARCELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3225 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9380
Mailing Address - Country:US
Mailing Address - Phone:719-275-2351
Mailing Address - Fax:
Practice Address - Street 1:714 FRONT ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3921
Practice Address - Country:US
Practice Address - Phone:719-486-0985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 1200941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker