Marie Joann Kistler, MS ED
Individual provider Active NPI Clinical Psychologist · Benidji, MN
NPI 1376528653 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1376528653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- LP0163 (MN)
- Practice address
- 403 4TH St NW
Ste 110
Benidji, MN 56601 - Phone
- (218) 759-2825
- Fax
- (218) 759-2825
- NPI assigned
- Dec 9, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP0163 | MN | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP0163 | MN | Yes |
Addresses
Primary practice location
403 4TH St NW
Ste 110
Benidji, MN 56601
Mailing address
PO Box 741
Bemidji, MN 56619
Phone (218) 759-2825
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.