Individual
KELLY KATHRYN HALVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
940 BELMONT ST, BROCKTON, MA 02301-5596
(763) 458-6156
Mailing address
3803 NW 23RD TER APT 101, GAINESVILLE, FL 32605-5643
(763) 458-6156
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
LP7054
MN
Other
Enumeration date
07/25/2024
Last updated
07/25/2024
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