Individual
DYLAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7010 HIGHWAY 7, ST LOUIS PARK, MN 55426-4223
(952) 814-0207
Mailing address
6496 KILLDEER DR, LINO LAKES, MN 55014-5462
(651) 354-8222
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/22/2019
Last updated
05/22/2019
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