Provider Demographics
NPI:1689319105
Name:GEHRICH, KRYSTIN
Entity type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:
Last Name:GEHRICH
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 1:913 SW HIGGINS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1423
Mailing Address - Country:US
Mailing Address - Phone:406-431-7764
Mailing Address - Fax:406-728-5178
Practice Address - Street 1:913 SW HIGGINS AVE STE 201
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1423
Practice Address - Country:US
Practice Address - Phone:406-431-7764
Practice Address - Fax:406-728-5178
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA1097441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker