Individual
KALLIE MARSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 5TH ST N, BRECKENRIDGE, MN 56520-1434
(218) 651-0212
Mailing address
115 5TH ST N, BRECKENRIDGE, MN 56520-1434
(218) 651-0212
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8-15-14
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1455895
—
ND
Enumeration date
10/16/2012
Last updated
07/21/2022
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