Individual
DR. KENNETH RAY YOUNG JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD, LP
Contact information
Practice address
9055 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5841
(763) 780-9155
(763) 236-1066
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP5036
MN
103TC0700X
Clinical Psychologist
LP5036
MN
103TC2200X
Clinical Child & Adolescent Psychologist
LP5036
MN
103TF0200X
Forensic Psychologist
LP5036
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083927917
—
MN
Enumeration date
07/20/2010
Last updated
12/07/2023
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