Individual
DR. LAURIE ANN BRUSTAD KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
600 DEMERS AVE, SUITE 404, GRAND FORKS, ND 58201-4599
(701) 746-4400
(701) 746-6034
Mailing address
600 DEMERS AVE, SUITE 404, GRAND FORKS, ND 58201-4599
(701) 746-4400
(701) 746-6034
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
222
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088174
VALUE OPTIONS
—
05
—
11915
—
ND
01
—
204771047933
PREFERRED ONE
—
01
—
308J3BR
BCBSMN
MN
01
—
5721265
FIRST HEALTH
—
01
—
A002
TRICARE
—
01
—
BRU21835
BCBSND
ND
01
—
HP1672
HEALTH PARTNERS
—
Enumeration date
04/02/2007
Last updated
07/08/2007
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