Organization
SHARON R KOUKKARI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON R KOUKKARI M.S., L.P. (PRESIDENT)
(612) 889-1692
Entity
Organization
Contact information
Practice address
5354 PARKDALE DR, SUITE 300, ST LOUIS PK, MN 55416-1603
(512) 889-1692
(952) 546-1445
Mailing address
19320 81ST PL N, MAPLE GROVE, MN 55311-1625
(612) 889-1692
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP1444
MN
Other
Enumeration date
10/01/2009
Last updated
10/01/2009
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