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Individual

MR. JON M KOLL

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MS CP

Contact information

Practice address
407 WASHINGTON ST, MONTICELLO, MN 55362-8815
(763) 295-4001
(763) 295-5086
Mailing address
1321 13TH ST N, ST CLOUD, MN 56303-2614
(320) 252-5010
(320) 203-1855

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2938
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
208GOKO
BLUE CROSS BLUE SHIELD
01
6250886
MEDICA
01
922241007838
PREFERRED ONE
01
HP27746
HEALTH PARTNERS
Enumeration date
06/19/2006
Last updated
07/08/2007
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