Provider Demographics
NPI:1518380708
Name:VINKEMEIER, KRISTYN MARIE
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:MARIE
Last Name:VINKEMEIER
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 1:101 INNER DR
Mailing Address - Street 2:
Mailing Address - City:LE SUEUR
Mailing Address - State:MN
Mailing Address - Zip Code:56058-2121
Mailing Address - Country:US
Mailing Address - Phone:763-232-3535
Mailing Address - Fax:
Practice Address - Street 1:101 INNER DR
Practice Address - Street 2:
Practice Address - City:LE SUEUR
Practice Address - State:MN
Practice Address - Zip Code:56058-2121
Practice Address - Country:US
Practice Address - Phone:763-232-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker