Healthcare Provider Details

I. General information

NPI: 1790615326
Provider Name (Legal Business Name): KIRSTEN BUCKINGHAM PHD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CLEVELAND AVE S
SAINT PAUL MN
55105-1208
US

IV. Provider business mailing address

1188 BISHOP ST STE 2904
HONOLULU HI
96813-3312
US

V. Phone/Fax

Practice location:
  • Phone: 651-371-5559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2323-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: