Provider Demographics
NPI:1215185350
Name:VALDIVIA, KRISTINE E (MA)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:E
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15875 FOLIAGE AVE.
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:651-895-2045
Mailing Address - Fax:
Practice Address - Street 1:2920 BRYANT AVE. SUITE #4
Practice Address - Street 2:
Practice Address - City:MPLS.
Practice Address - State:MN
Practice Address - Zip Code:55408
Practice Address - Country:US
Practice Address - Phone:651-895-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health