Organization
NORTHERN LIGHTS PSYCHOLOGICAL SERVICES P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA A KENNEDY PSY.D., L.P. (CEO)
(507) 828-1433
Entity
Organization
Contact information
Practice address
1010 FRONTIER DR, SUITE 104, FERGUS FALLS, MN 56537-1023
(507) 828-1433
Mailing address
PO BOX 3, UNDERWOOD, MN 56586-0003
(507) 828-1433
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP4330
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
589175200
—
MN
01
—
6178609
MEDICA
MN
01
—
978T6PS
BCBS OF MN
—
Enumeration date
10/14/2012
Last updated
10/14/2012
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