Individual
KELLY CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
3960 COON RAPIDS BLVD NW STE 200, COON RAPIDS, MN 55433-2589
(763) 236-9236
Mailing address
3960 COON RAPIDS BLVD NW STE 200, COON RAPIDS, MN 55433-2589
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
25205
MN
1041C0700X
Clinical Social Worker
25205
MN
Other
Enumeration date
08/03/2022
Last updated
01/17/2023
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