Provider Demographics
NPI:1578576930
Name:KOBIENIA, CARRIE L (MS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:KOBIENIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 2ND ST S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1314
Mailing Address - Country:US
Mailing Address - Phone:320-252-2976
Mailing Address - Fax:320-656-1570
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:SUITE 301
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1314
Practice Address - Country:US
Practice Address - Phone:320-252-2976
Practice Address - Fax:320-656-1570
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN602642700Medicaid