Provider Demographics
NPI:1306657135
Name:MEYERS, KRISTY KAY (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:KAY
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DAKOTA ST S
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56186-6000
Mailing Address - Country:US
Mailing Address - Phone:507-317-6956
Mailing Address - Fax:507-777-4284
Practice Address - Street 1:130 DAKOTA ST S
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MN
Practice Address - Zip Code:56186-6000
Practice Address - Country:US
Practice Address - Phone:507-317-6956
Practice Address - Fax:507-777-4284
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN313091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical