Organization
MCKZIEL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CREIGHTON JOHN MCKOWEN LP (OWNER)
(952) 445-7430
Entity
Organization
Contact information
Practice address
287 MARSCHALL RD, SUITE 204, SHAKOPEE, MN 55379-1686
(952) 445-7430
(952) 445-7430
Mailing address
287 MARSCHALL RD, SUITE 204, SHAKOPEE, MN 55379-1686
(952) 445-7430
(952) 445-7430
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1413
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30505MC
BCBS
MN
01
—
61-15251
UBH
MN
Enumeration date
02/08/2007
Last updated
08/22/2020
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