Healthcare Provider Details

I. General information

NPI: 1326829060
Provider Name (Legal Business Name): KRYSTEN CHAMBERLAIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 HOLLY RD
GRAND BLANC MI
48439-2443
US

IV. Provider business mailing address

PO BOX 6583
SAGINAW MI
48608-6583
US

V. Phone/Fax

Practice location:
  • Phone: 810-242-3740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121905
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801121905
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: