Provider Demographics
NPI:1790734598
Name:HYINK-HUTTEMIER, KRISTI LYNN (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:HYINK-HUTTEMIER
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LYNN
Other - Last Name:HYINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP
Mailing Address - Street 1:1880 AUSTIN ROAD
Mailing Address - Street 2:SUITE 2 MENTAL HEALTH PROFESSIONALS, INC.
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060
Mailing Address - Country:US
Mailing Address - Phone:507-446-8123
Mailing Address - Fax:507-446-0600
Practice Address - Street 1:1880 AUSTIN RD.
Practice Address - Street 2:STE. #2
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060
Practice Address - Country:US
Practice Address - Phone:507-446-8123
Practice Address - Fax:507-446-0600
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN512490500Medicaid