Healthcare Provider Details

I. General information

NPI: 1124566112
Provider Name (Legal Business Name): KRISTEN ELIZABETH WURTH LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KRISTEN ELIZABETH ARNOLD

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 SAVANNAH CT
YPSILANTI MI
48198-3681
US

IV. Provider business mailing address

1665 SAVANNAH CT
YPSILANTI MI
48198-3681
US

V. Phone/Fax

Practice location:
  • Phone: 517-914-1868
  • Fax:
Mailing address:
  • Phone: 517-914-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098881
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: