Provider Demographics
NPI:1003284621
Name:KIDMAN, YVETTE A (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:A
Last Name:KIDMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 3RD AVE SE STE 402
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4613
Mailing Address - Country:US
Mailing Address - Phone:507-218-8973
Mailing Address - Fax:507-206-0450
Practice Address - Street 1:300 3RD AVE SE STE 402
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4613
Practice Address - Country:US
Practice Address - Phone:507-218-8973
Practice Address - Fax:507-206-0450
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1003284621Medicaid