Active NPI
Krista Jo Dorgan, MA, LMFT
- Marriage & Family Therapist
- Hudson, WI
National Provider Identifier
1063930691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1155-124
- Practice address
- 2217 Vine Street #206
Hudson, WI 55001 - Phone
- (651) 998-4048
- NPI assigned
- Sep 4, 2017
- Last updated
- Sep 4, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 2809 | MN | |
| Marriage & Family Therapist | 106H00000X | 1155-124 | WI | Primary |
Addresses
Primary practice location
2217 Vine Street #206
Hudson, WI 55001
Mailing address
4723 Parsons Court South
Afton, MN 55001
Phone (612) 501-4228
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1155-124 | WI | MD | Marriage & Family Therapist |
| 2809 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504483200000",
"number": "1063930691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4723 PARSONS COURT SOUTH",
"city": "AFTON",
"state": "MN",
"postal_code": "55001",
"telephone_number": "612-501-4228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2217 VINE STREET #206",
"city": "HUDSON",
"state": "WI",
"postal_code": "55001",
"telephone_number": "651-998-4048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORGAN",
"first_name": "KRISTA",
"middle_name": "JO",
"credential": "MA, LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-04",
"last_updated": "2017-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "2809",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WI",
"license": "1155-124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hudson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.