Provider Demographics
NPI:1346229325
Name:REDLINGER-GROSSE, KRISTA ANNE (SCM)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:ANNE
Last Name:REDLINGER-GROSSE
Suffix:
Gender:F
Credentials:SCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 CARTER AVE # 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1638
Mailing Address - Country:US
Mailing Address - Phone:651-456-8874
Mailing Address - Fax:
Practice Address - Street 1:2239 CARTER AVE # 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1638
Practice Address - Country:US
Practice Address - Phone:651-456-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 170300000X
MNLP6234103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No170300000XOther Service ProvidersGenetic Counselor, MS