Provider Demographics
NPI:1881437309
Name:TREMMEL, KRISTEN REBECCA BADER (RCSWI, ISW15978)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:REBECCA BADER
Last Name:TREMMEL
Suffix:
Gender:F
Credentials:RCSWI, ISW15978
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:REBECCA
Other - Last Name:BADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RCSWI, ISW15978
Mailing Address - Street 1:1015 SIKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4499
Mailing Address - Country:US
Mailing Address - Phone:407-624-0442
Mailing Address - Fax:
Practice Address - Street 1:3125 BRUTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6608
Practice Address - Country:US
Practice Address - Phone:407-801-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW15978104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker