Provider Demographics
NPI:1588172266
Name:HEMSTOCK, KRISTIN RENAE (MA, LP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENAE
Last Name:HEMSTOCK
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CAREFREE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-2300
Mailing Address - Country:US
Mailing Address - Phone:507-625-7120
Mailing Address - Fax:
Practice Address - Street 1:1407 S STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-3715
Practice Address - Country:US
Practice Address - Phone:507-354-3181
Practice Address - Fax:507-354-3183
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3719103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP3719OtherLP LICENSE