Individual
KRISTAL ROSE MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
3381 GORHAM AVE, SAINT LOUIS PARK, MN 55426-4240
(952) 926-2600
Mailing address
3381 GORHAM AVE, SAINT LOUIS PARK, MN 55426-4240
(952) 926-2600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303641
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972927879
NPI
MN
Enumeration date
04/17/2017
Last updated
04/17/2017
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