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Individual
KRYSTEN WALL
Active
Individual
KRYSTEN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP00941504
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001733839
BC/BS
WV
01
—
290040
ANTHEM BC/BS
WV
05
—
3810002567
—
WV
01
—
481428
VALUE OPTIONS
WV
01
—
7379889
AETNA
WV
Enumeration date
10/11/2006
Last updated
03/28/2014
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