Healthcare Provider Details

I. General information

NPI: 1689582736
Provider Name (Legal Business Name): KEIRY E LANGSTAFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 21ST ST SE
AUSTIN MN
55912-4300
US

IV. Provider business mailing address

101 21ST ST SE
AUSTIN MN
55912-4300
US

V. Phone/Fax

Practice location:
  • Phone: 507-509-3259
  • Fax:
Mailing address:
  • Phone: 507-509-3259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33609
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: