Provider Demographics
NPI:1982271458
Name:GREW, KRISTIN (MAAC-AP, LADC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:GREW
Suffix:
Gender:F
Credentials:MAAC-AP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:BALSAM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54810-0233
Mailing Address - Country:US
Mailing Address - Phone:517-974-8054
Mailing Address - Fax:
Practice Address - Street 1:1294 18TH ST E
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3680
Practice Address - Country:US
Practice Address - Phone:651-437-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305773101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)