Healthcare Provider Details

I. General information

NPI: 1316388176
Provider Name (Legal Business Name): CAROL JEAN KUISLE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL JEAN HINDT

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MARSHALL ST
SAINT PETER MN
56082-4500
US

IV. Provider business mailing address

1407 S STATE ST
NEW ULM MN
56073-3715
US

V. Phone/Fax

Practice location:
  • Phone: 507-934-2652
  • Fax: 507-934-2654
Mailing address:
  • Phone: 507-354-3181
  • Fax: 507-354-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number576
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: