Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 140145 | MN |
NPI | 1043594252 |
---|---|
Provider Name | Mrs. Kinzie Elizabeth Eckstein |
First Address | White Bear Lake, MN 55110-6477 |
Second Address | New Ulm, MN 56073-3056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2011 |
Last Update Date | 18/09/2019 |