Individual
CONNOR KIMBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 23RD AVE SE, MINNEAPOLIS, MN 55455-0447
(763) 331-2961
Mailing address
10520 MISSISSIPPI CIR N, BROOKLYN PARK, MN 55443-1267
(763) 331-2961
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JZH133820080001
BLUECROSS BLUESHIELD
—
Enumeration date
06/10/2022
Last updated
06/10/2022
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