Provider Demographics
NPI:1699452110
Name:KIVISTO, BETH K
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:K
Last Name:KIVISTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:K
Other - Last Name:L'ESPERANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:327 13TH ST S STE 110
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-4641
Mailing Address - Country:US
Mailing Address - Phone:763-972-3447
Mailing Address - Fax:763-972-3734
Practice Address - Street 1:327 13TH ST S STE 110
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-4641
Practice Address - Country:US
Practice Address - Phone:763-972-3447
Practice Address - Fax:763-972-3734
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist