Provider Demographics
NPI:1376132910
Name:RICH, KRISTIN ROSE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ROSE
Last Name:RICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ROSE
Other - Last Name:MALINOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1330 E SUPERIOR ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-3929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 E SUPERIOR ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-409-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2025-05-21
Deactivation Date:2025-04-24
Deactivation Code:
Reactivation Date:2025-05-20
Provider Licenses
StateLicense IDTaxonomies
MN4963101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health