Healthcare Provider Details

I. General information

NPI: 1356698294
Provider Name (Legal Business Name): KRISTEN L WIIK PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6720
  • Fax: 651-220-6707
Mailing address:
  • Phone: 651-220-6720
  • Fax: 651-220-6707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP 5495
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: