Provider Demographics
NPI:1801597323
Name:CREASEY, KIMBERLY KAY (MA PENDING (JUNE23))
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:CREASEY
Suffix:
Gender:F
Credentials:MA PENDING (JUNE23)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 BEAM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1162
Mailing Address - Country:US
Mailing Address - Phone:651-661-6550
Mailing Address - Fax:
Practice Address - Street 1:1856 BEAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1162
Practice Address - Country:US
Practice Address - Phone:651-661-6550
Practice Address - Fax:651-661-6551
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional