Provider Demographics
NPI:1790285443
Name:FRONRATH, KRISTINA ANGELA (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANGELA
Last Name:FRONRATH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47110 LIBERTY BELL RD E
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2573
Mailing Address - Country:US
Mailing Address - Phone:862-723-7415
Mailing Address - Fax:
Practice Address - Street 1:41400 DEQUINDRE RD STE 110
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3751
Practice Address - Country:US
Practice Address - Phone:586-580-2975
Practice Address - Fax:586-580-2954
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011017351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790285443Medicaid