MS. KRYSTAL BOURGEOIS BSW SAC-IT NPI 1982154779

NPI Information

NPI: 1982154779
Provider Name: MS. KRYSTAL BOURGEOIS, BSW, SAC-IT
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
2677 N 40TH ST
MILWAUKEE, WI
ZIP 53210
Phone: (414) 447-1965
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MS. Krystal Bourgeois, BSW, SAC-IT is an addiction (substance use disorder) counselor in Milwaukee, WI. MS. Krystal Bourgeois, BSW, SAC-IT NPI is 1982154779. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2677 N 40TH ST
MILWAUKEE, WI
ZIP 53210-505
Phone: (414) 447-1965
Fax: (414) 447-1964

The enumeration date for this NPI number is 10/5/2016 and was last updated on 2/16/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	16764-130	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	261QM0801X	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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