Individual
KILLY KITZMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, LPC-IT
Contact information
Practice address
6640 SHADY OAK RD STE 401, EDEN PRAIRIE, MN 55344-7834
(715) 256-7166
(888) 427-8048
Mailing address
800 WILSON AVE RM 330, MENOMONIE, WI 54751-2746
(715) 256-7166
(888) 427-8048
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
307059
MN
101YM0800X
Mental Health Counselor
Primary
8849-226
WI
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/19/2024
Last updated
01/14/2026
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