Doctor Name: | KRISTINE KELLY KONRAD |
NPI Number: | 1073525663 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | |
Business Practice Address: | 421 Nebraska St Sturgeon Bay, WI - 542352249 |
Business Phone Number: | 9207467113 |
Business Fax Number: | |
Mailing Address: | 4128 Saint Francis Park Cir, GREEN BAY |
State: | WI |
Postal Code: | 543138433 |
Phone Number: | 9204347053 |
Fax Number: | |
NPI Enumeration Date: | 08/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |