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General NPI Number Information
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NPI Number | 1902994031
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Entity Type | Individual
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Provider Name | KRISTA DUCKETT LISW
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 86 MDG UNIT 3215 RAMSTEIN AB
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City | APO
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State | AE
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Zip | 09094-3215
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Country | US
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Telephone | 314-479-2390
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 2 BOX 10873
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City | APO
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State | AE
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Zip | 09012-0109
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Country | US
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Telephone | 864-553-2009
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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 | I0600088
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License Number State | OH
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