Provider Demographics
NPI:1932975208
Name:GILBERTSON, KRISTA R
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:R
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HOYT ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2069
Mailing Address - Country:US
Mailing Address - Phone:989-494-8466
Mailing Address - Fax:
Practice Address - Street 1:3290 W BIG BEAVER RD STE 510
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2917
Practice Address - Country:US
Practice Address - Phone:989-494-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician