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General NPI Number Information
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NPI Number | 1891436366
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Entity Type | Organization
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Legal Business Name | KRISTA DEMUTH LLC
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 08/27/2022
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Provider Practice Location Address
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Address Line | 815 DAVIS ST
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City | HAMMOND
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State | WI
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Zip | 54015-9808
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Country | US
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Telephone | 612-567-9881
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Fax |
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Provider Business Mailing Address
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Address Line | 625 KLEIN DR
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City | HAMMOND
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State | WI
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Zip | 54015-9798
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Country | US
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Telephone | 715-410-1280
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTA J DEMUTH
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Credential | MS, LPC
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Telephone | 715-410-1280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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