Healthcare Provider Details

I. General information

NPI: 1265348544
Provider Name (Legal Business Name): MADELINE KAPHINGST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADDIE KAPHINGST

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 PORTLAND AVE
BURNSVILLE MN
55337-1516
US

IV. Provider business mailing address

8701 XERXES AVE S
MINNEAPOLIS MN
55431-1964
US

V. Phone/Fax

Practice location:
  • Phone: 612-568-6050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: