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NPI Code Detail

MEDICARE: KRISTINE KAY KIENLEN PSY.D.

MEDICARE: KRISTINE KAY KIENLEN PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistLP3545MN

General Provider Information

NPI Number : 1689732182
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINE KAY KIENLEN PSY.D.
Provider Business Mailing Address
First Line : 5245 JAMES AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1136
Country : US
Telephone Number : 612-799-4181
Fax Number :
Provider Business Practice Location Address
First Line : 5245 JAMES AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1136
Country : US
Telephone Number : 612-799-4181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 07/08/2007

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