Individual
KELLY SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12918 63RD AVE N, MAPLE GROVE, MN 55369-6001
(612) 554-3737
Mailing address
4624 DEERWOOD DR, MINNETONKA, MN 55343-8679
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/21/2018
Last updated
01/08/2026
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