Provider Demographics
NPI:1225048242
Name:FINCH, KIMBERLY ALLEN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ALLEN
Last Name:FINCH
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 HAMLINE AVE N
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5009
Mailing Address - Country:US
Mailing Address - Phone:651-636-0099
Mailing Address - Fax:651-636-1075
Practice Address - Street 1:2233 HAMLINE AVE N
Practice Address - Street 2:SUITE 217
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-5009
Practice Address - Country:US
Practice Address - Phone:651-636-0099
Practice Address - Fax:651-636-1075
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 4500103TC0700X, 103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN504122800Medicaid