Provider Demographics
NPI:1225609522
Name:ZIEMKE, KRISTIN KAY (MT-BC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KAY
Last Name:ZIEMKE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 398TH AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56048-1611
Mailing Address - Country:US
Mailing Address - Phone:507-382-1350
Mailing Address - Fax:
Practice Address - Street 1:311 398TH AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56048-1611
Practice Address - Country:US
Practice Address - Phone:507-382-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN08313225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist