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General NPI Number Information
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NPI Number | 1669796058
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Entity Type | Organization
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Legal Business Name | KRISTIN S. KILDAHL, MA, LP, LLC
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 7200 FRANCE AVE S
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City | EDINA
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State | MN
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Zip | 55435-4300
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Country | US
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Telephone | 612-272-5107
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Fax | 651-730-6657
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Provider Business Mailing Address
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Address Line | 9923 BROOKSIDE CIR
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2826
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Country | US
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Telephone | 612-272-5107
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Fax | 651-730-6657
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MS. KRISTIN SKOOG KILDAHL
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Credential | MA, LP
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Telephone | 612-272-5107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP1384
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License Number State | MN
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