Healthcare Provider Details

I. General information

NPI: 1962798942
Provider Name (Legal Business Name): KRISTIN NEVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 7TH AVE
ANOKA MN
55303-4516
US

IV. Provider business mailing address

3301 7TH AVE
ANOKA MN
55303-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-431-5110
  • Fax:
Mailing address:
  • Phone: 651-431-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP6993
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: