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1285076919 NPI number — KRYSTA VITEK LCSW

NPI Number: 1285076919
Health Care Provider/Practitioner: KRYSTA VITEK LCSW

Information about “1285076919” NPI (KRYSTA VITEK LCSW) exists in 1285076919 in HTML format HTML  |  1285076919 in plain Text format TXT  |  1285076919 in PDF (Portable Document Format) PDF  |  1285076919 in an XML format XML  formats.

NPI Number : 1285076919 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285076919",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VITEK",
    "FirstName": "KRYSTA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MATTHEWS",
    "OtherFirstName": "KRYSTA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "255 BLUE LAKES BLVD N # 633",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TWIN FALLS",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83301-5238",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-736-5048",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "601 POLE LINE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TWIN FALLS",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83301-3035",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-308-2021",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/23/2013",
    "LastUpdateDate": "10/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "LCSW-31959",
        "LicenseNumberStateCode": "ID",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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