Individual
KRIS MALLON HENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
932 EAST 34TH STREET, MINNEAPOLIS, MN 55407
(612) 204-8540
Mailing address
1121 E 46TH ST, MINNEAPOLIS, MN 55407-3562
(612) 204-8540
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17387
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106649800
—
MN
Enumeration date
10/24/2006
Last updated
06/26/2018
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