Organization
KWST TARGETED BEHAVIORAL DEVELOPMENT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEARY WAYNE SAFFOLD MED (PRESIDENT)
(612) 518-6009
Entity
Organization
Contact information
Practice address
333 WASHINGTON AVE N STE 323, MINNEAPOLIS, MN 55401-1366
(612) 518-6009
Mailing address
333 WASHINGTON AVE N STE 323, MINNEAPOLIS, MN 55401-1366
(612) 518-6009
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
261QS1000X
Student Health Clinic/Center
—
—
Other
Enumeration date
07/20/2020
Last updated
12/08/2022
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