Provider Demographics
NPI:1487768198
Name:KIRKMAN, ANNA MARIE (MA LP)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:KIRKMAN
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:ZADOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LP
Mailing Address - Street 1:1407 S STATE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073
Mailing Address - Country:US
Mailing Address - Phone:507-354-3181
Mailing Address - Fax:507-354-3183
Practice Address - Street 1:1407 S STATE STREET
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073
Practice Address - Country:US
Practice Address - Phone:507-354-3181
Practice Address - Fax:507-354-3183
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
113381OtherUCARE BHP
943071022574OtherPREFERRED ONE
113381OtherUCARE BHP
943071022574OtherPREFERRED ONE