Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 305060 | MN |
NPI | 1003454356 |
---|---|
Provider Name | Kyle Lipinski |
First Address | Saint Paul, MN 55107-2226 |
Second Address | Saint Paul, MN 55102-1081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2019 |
Last Update Date | 19/12/2019 |