Individual
DR. KERRY RYAN BROCKBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., LP
Contact information
Practice address
11850 BLACKFOOT ST NW STE 405, MINNEAPOLIS, MN 55433-2773
(763) 236-0888
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP6410
MN
Other
Enumeration date
12/14/2017
Last updated
05/18/2021
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