Individual
MR. KEITH LESLIE DERAAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPRP
Contact information
Practice address
1825 CHICAGO AVE, MINNEAPOLIS, MN 55404-1939
(612) 752-8246
(612) 752-8203
Mailing address
3700 W 83RD ST, BLOOMINGTON, MN 55431-1063
(952) 842-8273
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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