Provider Demographics
NPI:1083025845
Name:PFEIFF, KRISTIN LYNNE
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:LYNNE
Last Name:PFEIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47049 152ND ST
Mailing Address - Street 2:
Mailing Address - City:TWIN BROOKS
Mailing Address - State:SD
Mailing Address - Zip Code:57269-5800
Mailing Address - Country:US
Mailing Address - Phone:701-367-5559
Mailing Address - Fax:
Practice Address - Street 1:47049 152ND ST
Practice Address - Street 2:
Practice Address - City:TWIN BROOKS
Practice Address - State:SD
Practice Address - Zip Code:57269-5800
Practice Address - Country:US
Practice Address - Phone:701-367-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD67327-3252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency