Individual
KYLIE RENEE ANNE MATHIEU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
520 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-4105
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305548
MN
Other
Enumeration date
03/22/2024
Last updated
10/10/2024
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