Provider Demographics
NPI:1891017182
Name:KINSTAD, LORI DINA (LICSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DINA
Last Name:KINSTAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439
Mailing Address - Country:US
Mailing Address - Phone:612-655-5214
Mailing Address - Fax:612-500-4847
Practice Address - Street 1:5275 EDINA INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:612-655-5214
Practice Address - Fax:612-500-4847
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical