MEDICARE: KRISTEN DINGWALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		CO
2	1041C0700X	Clinical Social Worker	09928833	CO

General Provider Information

NPI Number	:	1912648106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN DINGWALL

Provider Business Mailing Address
First Line	:	2625 REDWING RD STE 370
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6314
Country	:	US
Telephone Number	:	303-931-8813
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 REDWING RD STE 370
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6314
Country	:	US
Telephone Number	:	303-931-8813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	01/22/2024

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Directions to “ KRISTEN DINGWALL ” Practice Location

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