Individual
KRISTINA LYNN ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
40 11TH ST, CLOQUET, MN 55720-1817
(218) 879-4559
Mailing address
3558 MILITARY RD, MOOSE LAKE, MN 55767-8165
(915) 246-6045
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/04/2025
Last updated
04/04/2025
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