Provider Demographics
NPI:1972780922
Name:FAUL, KIRI ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KIRI
Middle Name:ANN
Last Name:FAUL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S 8TH ST
Mailing Address - Street 2:604 PARKSIDE PROFESSIONAL CENTER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1208
Mailing Address - Country:US
Mailing Address - Phone:612-333-3825
Mailing Address - Fax:612-333-6740
Practice Address - Street 1:825 S 8TH ST
Practice Address - Street 2:604 PARKSIDE PROFESSIONAL CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1208
Practice Address - Country:US
Practice Address - Phone:612-333-3825
Practice Address - Fax:612-333-6740
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4895103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist