Individual
KENNETH MARTINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
302 S 2ND ST, MANKATO, MN 56001-3605
(507) 388-8114
(507) 388-8068
Mailing address
302 S 2ND ST, MANKATO, MN 56001-3605
(507) 388-8114
(507) 388-8068
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
LP2702
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136327
—
MN
01
—
30407-01
VALUE OPTIONS
MN
01
—
473T4MA
MN BCBS
MN
01
—
HP42906
HEALTH PARTNERS
MN
Enumeration date
09/25/2006
Last updated
07/09/2007
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