Provider Demographics
NPI:1386440873
Name:HALVORSON, KRISTA ANN
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:HALVORSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:VANHEUVELN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 10TH AVENUE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387
Mailing Address - Country:US
Mailing Address - Phone:320-200-1342
Mailing Address - Fax:
Practice Address - Street 1:314 10TH AVENUE S
Practice Address - Street 2:SUITE 100
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-5630
Practice Address - Country:US
Practice Address - Phone:320-200-1342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician