Individual
KELLY J COUGHLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3960 COON RAPIDS BLVD NW STE 220, COON RAPIDS, MN 55433-2589
(763) 236-8438
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1578
MN
Other
Enumeration date
10/26/2005
Last updated
05/30/2024
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