Individual
KRISTEN JEAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MATS LSW
Contact information
Practice address
8000 MELTON RD, GARY, IN 46403-3114
(219) 938-4651
(219) 938-4679
Mailing address
8000 MELTON RD, GARY, IN 46403-3114
(219) 938-4651
(219) 938-4679
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
99090505A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841412996
—
IN
Enumeration date
08/16/2019
Last updated
08/16/2019
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