Individual
KATHLEEN JACKLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC/AUD
Contact information
Practice address
1101 9TH ST N, VIRGINIA, MN 55792-2329
(218) 741-0150
Mailing address
1101 9TH ST N, VIRGINIA, MN 55792-2329
(218) 741-0150
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
5683
MN
Other
Enumeration date
05/13/2009
Last updated
05/13/2009
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