Provider Demographics
NPI:1649707092
Name:MASHAK, KRISTA (LLMSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MASHAK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 JESSOP RD
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48819-9615
Mailing Address - Country:US
Mailing Address - Phone:517-898-4231
Mailing Address - Fax:
Practice Address - Street 1:2700 BAKER ST FL 3
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2157
Practice Address - Country:US
Practice Address - Phone:231-737-1133
Practice Address - Fax:231-737-0534
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical