Individual
JOAN KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1025 DODD RD, SAINT PAUL, MN 55118-1113
(651) 450-2220
Mailing address
5918 CAMBRIDGE ST, ST LOUIS PARK, MN 55416-5117
(952) 913-0354
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
174609
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174609
CPRP
MN
Enumeration date
04/13/2007
Last updated
07/08/2007
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