Provider Demographics
NPI:1770900508
Name:CHASE, KRISTLE ANN (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTLE
Middle Name:ANN
Last Name:CHASE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55908 CSAH 3
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:56243-2017
Mailing Address - Country:US
Mailing Address - Phone:320-221-1419
Mailing Address - Fax:
Practice Address - Street 1:507 N SIBLEY AVE STE 1A
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-1754
Practice Address - Country:US
Practice Address - Phone:320-221-9892
Practice Address - Fax:855-564-1894
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN186911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical