Individual
MRS. CRYSTAL LEE KIECKHOEFER O'MALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.E., CCC-SLP
Contact information
Practice address
1891 STATION PKWY NW, ANDOVER, MN 55304-4259
(763) 755-4275
Mailing address
1891 STATION PKWY NW, ANDOVER, MN 55304-4259
(763) 755-4275
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
3282-154
WI
235Z00000X
Speech-Language Pathologist
Primary
8889
MN
Other
Enumeration date
08/18/2009
Last updated
01/12/2017
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