Provider Demographics
NPI:1912508243
Name:KRECKLAU, ARIANA BARBARA KAY (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:ARIANA
Middle Name:BARBARA KAY
Last Name:KRECKLAU
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:ARIANA
Other - Middle Name:BARBARA KAY
Other - Last Name:KIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 WESTRAC DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2338
Mailing Address - Country:US
Mailing Address - Phone:701-280-9545
Mailing Address - Fax:
Practice Address - Street 1:1202 WESTRAC DR S STE 400
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2356
Practice Address - Country:US
Practice Address - Phone:701-280-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker