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Individual

KELSEY JEAN VAN VICKLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1935 COUNTY ROAD B2 W STE 100, ROSEVILLE, MN 55113-2722
(651) 636-4155
(651) 636-3595
Mailing address
1947 STINSON BLVD, MINNEAPOLIS, MN 55418-4820
(612) 229-4087

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9542
MN

Other

Enumeration date
08/17/2015
Last updated
08/17/2015
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