Healthcare Provider Details

I. General information

NPI: 1144642745
Provider Name (Legal Business Name): KRISTY HOMMERDING M.A., L.P.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 1ST ST N STE 101
SAINT CLOUD MN
56303-1924
US

IV. Provider business mailing address

5354 PARKDALE DR 2ND FLOOR
ST LOUIS PARK MN
55416-1603
US

V. Phone/Fax

Practice location:
  • Phone: 612-268-5858
  • 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
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number01392
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: