1790734598 NPI number — KRISTI LYNN HYINK-HUTTEMIER PSYD., L.P.

Table of content: KRISTI LYNN HYINK-HUTTEMIER PSYD., L.P. (NPI 1790734598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790734598 NPI number — KRISTI LYNN HYINK-HUTTEMIER PSYD., L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYINK-HUTTEMIER
Provider First Name:
KRISTI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD., L.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HYINK
Provider Other First Name:
KRISTI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790734598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1880 AUSTIN ROAD
Provider Second Line Business Mailing Address:
SUITE 2 MENTAL HEALTH PROFESSIONALS, INC.
Provider Business Mailing Address City Name:
OWATONNA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-446-8123
Provider Business Mailing Address Fax Number:
507-446-0600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 AUSTIN RD.
Provider Second Line Business Practice Location Address:
STE. #2
Provider Business Practice Location Address City Name:
OWATONNA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-446-8123
Provider Business Practice Location Address Fax Number:
507-446-0600
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP4355 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 512490500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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