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General NPI Number Information
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NPI Number | 1629518949
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Entity Type | Individual
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Provider Name | STACIE KREIGER
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Gender | Female
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 4518 W TILL RD
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City | FORT WAYNE
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State | IN
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Zip | 46818-9389
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Country | US
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Telephone | 260-438-9838
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Fax |
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Provider Business Mailing Address
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Address Line | 625 111TH AVE N
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City | NAPLES
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State | FL
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Zip | 34108-1825
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Country | US
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Telephone | 260-438-9838
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13531
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License Number State | FL
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