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General NPI Number Information
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NPI Number | 1861843385
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Entity Type | Individual
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Provider Name | KRISTIE LERVICK LADC
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Gender | Female
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 1 ST CROIX LOFTS DR 101
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City | SAINT CROIX FALLS
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State | WI
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Zip | 54024-9127
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Country | US
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Telephone | 952-836-5473
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ST CROIX LOFTS DRIVE 101
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City | ST CROIX FALLS
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State | WI
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Zip | 54024
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Country | US
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Telephone | 952-836-5473
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 302539
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License Number State | MN
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