Provider Demographics
NPI:1336248210
Name:AYDT, KRISTIN (LMFT)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:AYDT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 COUNTY ROAD 42 W STE 309
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6213
Mailing Address - Country:US
Mailing Address - Phone:952-808-1400
Mailing Address - Fax:952-808-1400
Practice Address - Street 1:79 13TH AVE NE STE 103B
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1071
Practice Address - Country:US
Practice Address - Phone:952-808-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7743384OtherMINNESOTA TAX ID NUMBER
MN742647000OtherMHCP PROVIDER NUMBER