Individual
MRS. KIMBERLY JEAN SLETTA AVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
722 15TH STREET N.W., BEMIDJI, MN 56619-0640
(218) 751-3280
(218) 751-3298
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
15400
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153485800
—
MN
Enumeration date
09/25/2006
Last updated
12/13/2019
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