Kjirstyn Lee Wicklund, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2014 Issued in MN

Practice address

44 Good Counsel Dr
Mankato, MN 56001-6599

Phone

(800) 438-1772

Fax

(262) 345-5562

NPI assigned

Dec 15, 2016

Last updated

Feb 27, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kjristyn Birkholz Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wisconsin Lutheran Child & Family Service, Inc

  dba Christian Family Counseling

  • Clinical Psychologist
  • Mankato, MN
  • NPI 1669758520

  Professional

  NPD (past)
• Wisconsin Lutheran Child and Family Service Inc

  dba Christian Family Solutions

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Germantown, WI
  • NPI 1083786628

  Professional

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1255875829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W175N11120 STONEWOOD DR",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226511",
            "telephone_number": "800-438-1772",
            "fax_number": "262-293-9737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 GOOD COUNSEL DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016599",
            "telephone_number": "800-438-1772",
            "fax_number": "262-345-5562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLUND",
        "first_name": "KJIRSTYN",
        "middle_name": "LEE",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-15",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "01933",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "2014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KJRISTYN",
            "last_name": "BIRKHOLZ",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Emily Josefina White, DC
• Haylee Ann White
• Wendy Ann Carlson White, DPT
• Nichole Elizabeth Whitlock
• Tyler Joseph Wayne Whitworth
• Taryn Wicks, LICSW
• Carlin Lee Wiemers, DDS, MS
• Tania Rae Wieseler, PHARMD
• Madison Ann Wilde
• Wildrose Home Health Services, Inc.

• Professional Counselor in Mankato, MN
• Providers in Mankato, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.