Provider Demographics
NPI:1568208700
Name:GUTKNECHT, KRISTEN ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:GUTKNECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SW 28TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7077
Mailing Address - Country:US
Mailing Address - Phone:515-230-7736
Mailing Address - Fax:
Practice Address - Street 1:2331 E 8TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-1715
Practice Address - Country:US
Practice Address - Phone:515-210-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)