Provider Demographics
NPI:1487781514
Name:MEYER-RUBADO, KRISTINE M (MA, LP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:MEYER-RUBADO
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:M
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LP, PLLC
Mailing Address - Street 1:975 34TH AVE NW
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901
Mailing Address - Country:US
Mailing Address - Phone:507-288-5818
Mailing Address - Fax:507-424-1052
Practice Address - Street 1:975 34TH AVE NW
Practice Address - Street 2:SUITE 215
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901
Practice Address - Country:US
Practice Address - Phone:507-288-5818
Practice Address - Fax:507-424-1052
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3442103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP29916OtherHEALTHPARTNERS
MN921001022822OtherPREFERRED ONE
MN39P82MEOtherBCBS OF MN
MN140013OtherUCARE
MN158223200Medicaid