Individual
DR. MARY LYNN KITTELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP, JUNGIAN ANALYST
Contact information
Practice address
1711 COUNTY ROAD B W, SUITE 205-S, ROSEVILLE, MN 55113-4057
(651) 276-0305
Mailing address
1975 PRIOR AVE N, SAINT PAUL, MN 55113-5406
(651) 489-7484
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
—
ZZ
103T00000X
Psychologist
Primary
2078
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1409168
MN STATE TAX ID
MN
01
—
P911100
NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF PSYCHOANALYSIS
NY
Enumeration date
07/22/2008
Last updated
07/22/2008
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