MEDICARE: MRS. KRISTIN WENTZ-KRUMWIEDE LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	4860	ND

General Provider Information

NPI Number	:	1578953642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN WENTZ-KRUMWIEDE LSW

Provider Business Mailing Address
First Line	:	106 2ND AVE
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529
Country	:	US
Telephone Number	:	701-622-3706
Fax Number	:	701-622-3045

Provider Business Practice Location Address
First Line	:	106 SECOND AVENUE NORTH EAST
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529-0278
Country	:	US
Telephone Number	:	701-622-3706
Fax Number	:	701-622-3045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	04/03/2015

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