Provider Demographics
NPI:1427522127
Name:HINNENKAMP, KHRISTINA R (LICSW)
Entity type:Individual
Prefix:MISS
First Name:KHRISTINA
Middle Name:R
Last Name:HINNENKAMP
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 1:1037 IGLEHART AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5590
Mailing Address - Country:US
Mailing Address - Phone:320-491-0136
Mailing Address - Fax:
Practice Address - Street 1:1037 IGLEHART AVE APT 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5590
Practice Address - Country:US
Practice Address - Phone:320-491-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN228491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical