Organization
KRISTIN S. KILDAHL, MA, LP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTIN SKOOG KILDAHL MA, LP (PSYCHOLOGIST)
(612) 272-5107
Entity
Organization
Contact information
Practice address
7200 FRANCE AVE S, EDINA, MN 55435-4300
(612) 272-5107
(651) 730-6657
Mailing address
9923 BROOKSIDE CIR, BLOOMINGTON, MN 55431-2826
(612) 272-5107
(651) 730-6657
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP1384
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578643730
TYPE 1 NPI #
MN
05
—
1578643730
—
MN
Enumeration date
03/15/2010
Last updated
03/16/2010
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