Individual
KENNETH L. STAPLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
423 NE 4TH ST STE 2, GRAND RAPIDS, MN 55744-2968
(218) 326-5694
(218) 326-5313
Mailing address
PO BOX 771, GRAND RAPIDS, MN 55744-0771
(218) 326-5694
(218) 326-5313
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3021
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104205319
NPI2
MN
05
—
796713600
—
MN
Enumeration date
12/26/2005
Last updated
12/05/2024
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