Provider Demographics
NPI:1871997544
Name:INEICHEN, KRISTIE A (PSYD LP)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:A
Last Name:INEICHEN
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5683 530TH ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-5111
Mailing Address - Country:US
Mailing Address - Phone:763-257-4655
Mailing Address - Fax:
Practice Address - Street 1:N5683 530TH ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-5111
Practice Address - Country:US
Practice Address - Phone:763-257-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4031-57103TC0700X
MNLP5823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical