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Individual

KARY J GILLENWATERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
15590 90TH ST NE, OTSEGO, MN 55330-9452
(763) 755-4275
Mailing address
15590 90TH ST NE, OTSEGO, MN 55330-9452
(763) 755-4275

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1458
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
018808
BCBS OF ND PIN
ND
Enumeration date
08/03/2006
Last updated
02/06/2014
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