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General NPI Number Information
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NPI Number | 1285076919
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Entity Type | Individual
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Provider Name | KRYSTA VITEK LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 601 POLE LINE RD
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City | TWIN FALLS
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State | ID
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Zip | 83301-3035
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Country | US
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Telephone | 208-308-2021
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Fax |
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Provider Business Mailing Address
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Address Line | 255 BLUE LAKES BLVD N # 633
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City | TWIN FALLS
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State | ID
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Zip | 83301-5238
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Country | US
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Telephone | 208-736-5048
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-31959
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License Number State | ID
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