Healthcare Provider Details

I. General information

NPI: 1558052852
Provider Name (Legal Business Name): KRYSTOL TOFSTAD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 44TH ST S
FARGO ND
58104-6069
US

IV. Provider business mailing address

5147 44TH ST S
FARGO ND
58104-6069
US

V. Phone/Fax

Practice location:
  • Phone: 701-369-3181
  • Fax: 701-781-8012
Mailing address:
  • Phone: 701-781-3181
  • Fax: 701-781-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6521
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36291
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: