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General NPI Number Information
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NPI Number | 1154610210
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Entity Type | Individual
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Provider Name | KRISTEN MAGNUS MSW
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Gender | Female
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 1407 SAINT ANDREW ST STE 100
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City | LA CROSSE
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State | WI
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Zip | 54603-2378
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Country | US
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Telephone | 715-743-5430
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Fax |
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Provider Business Mailing Address
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Address Line | W5720 MAPLE RD
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City | NEILLSVILLE
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State | WI
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Zip | 54456-7240
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Country | US
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Telephone | 715-937-5525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 127867-121
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License Number State | WI
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