Healthcare Provider Details

I. General information

NPI: 1477113843
Provider Name (Legal Business Name): KRISTEN ELISE DRESBACH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 E SOUTHWAY BLVD
KOKOMO IN
46902-3650
US

IV. Provider business mailing address

1017 W EUCLID AVE
MARION IN
46952-3486
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-4843
  • Fax: 765-450-4895
Mailing address:
  • Phone: 630-864-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: