Provider Demographics
NPI:1265958375
Name:MARIN, KRISTEN MARIE (LP)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARIE
Last Name:MARIN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:ASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF WISCONSIN-LA CROSSE, 1725 STATE STREET
Mailing Address - Street 2:2106 CENTENNIAL HALL
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3742
Mailing Address - Country:US
Mailing Address - Phone:608-785-8073
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF WISCONSIN-LA CROSSE, 1725 STATE STREET
Practice Address - Street 2:2106 CENTENNIAL HALL
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3742
Practice Address - Country:US
Practice Address - Phone:608-785-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3063-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical