Individual
MR. BRUCE ALLAN KOHLHASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., L.P.
Contact information
Practice address
4826 CHICAGO AVE. S., SUITE 104, MINNEAPOLIS, MN 55417-1055
(612) 823-1507
Mailing address
4826 CHICAGO AVE. S., SUITE 104, MINNEAPOLIS, MN 55417-1055
(612) 823-1507
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 1960
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G337KO
BLUE CROSS/BLUE SHIELD
MN
01
—
62-68428
MEDICA-UBH NUMBER
MN
Enumeration date
10/04/2006
Last updated
07/09/2007
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