Healthcare Provider Details

I. General information

NPI: 1487781514
Provider Name (Legal Business Name): KRISTINE M MEYER-RUBADO MA, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE M MEYER MA, LP, PLLC

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 34TH AVE NW SUITE 215
ROCHESTER MN
55901
US

IV. Provider business mailing address

975 34TH AVE NW SUITE 215
ROCHESTER MN
55901
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-5818
  • Fax: 507-424-1052
Mailing address:
  • Phone: 507-288-5818
  • Fax: 507-424-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3442
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP3442
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: