Provider Demographics
NPI:1245779552
Name:KAMINSKI-WADLE, KRISTIN LYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LYN
Last Name:KAMINSKI-WADLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:LYN
Other - Last Name:KAMINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:701 HIGH ST STE 227
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-4727
Mailing Address - Country:US
Mailing Address - Phone:916-802-3281
Mailing Address - Fax:
Practice Address - Street 1:701 HIGH ST STE 227
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4727
Practice Address - Country:US
Practice Address - Phone:530-500-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSYCHOLOGY390200000X
CAPSY30967103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program