Individual
KRISTINE LEE EDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
504 S 2ND AVE, VIRGINIA, MN 55792
(218) 212-5700
Mailing address
PO BOX 498, BIWABIK, MN 55708-0498
(218) 591-6023
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2875
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2875
MN BOARD OF BEHAVIORAL HEALTH AND THERAPY
MN
Enumeration date
10/02/2019
Last updated
05/31/2022
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