| Doctor Name: | MS. RANDI ADELE KROGSTAD |
| NPI Number: | 1235116526 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | 111004 |
| Business Practice Address: | 29 Pine Street George B. Wells Human Services Southbridge, MA - 015501891 |
| Business Phone Number: | 5087659167 |
| Business Fax Number: | 5087642462 |
| Mailing Address: | 18 Colburn Rd, STAFFORD SPRINGS |
| State: | CT |
| Postal Code: | 060763407 |
| Phone Number: | 8606847215 |
| Fax Number: | |
| NPI Enumeration Date: | 12/28/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 111004 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |