Individual
KALLIE JOY BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14301 EWING AVE S, BURNSVILLE, MN 55306-4885
(952) 746-5350
Mailing address
200 4TH AVE W, SHAKOPEE, MN 55379-1220
(952) 496-8481
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
28361
MN
Other
Enumeration date
04/26/2018
Last updated
05/31/2023
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