Provider Demographics
NPI:1518053479
Name:KIGIN, MARIE THERESE
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:THERESE
Last Name:KIGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3974
Mailing Address - Country:US
Mailing Address - Phone:320-252-2706
Mailing Address - Fax:
Practice Address - Street 1:2411 1ST ST S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3974
Practice Address - Country:US
Practice Address - Phone:320-252-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207072-3-CEC385H00000X
MN1023555-2-AFC385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care