Provider Demographics
NPI:1235805813
Name:ALLEN, KIRSTEN (MS, ATC, CES)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:GOODVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55987-1758
Mailing Address - Country:US
Mailing Address - Phone:847-436-3422
Mailing Address - Fax:
Practice Address - Street 1:855 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4868
Practice Address - Country:US
Practice Address - Phone:507-454-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer