Individual
MS. KIM TRACY ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
7580 160TH ST W, LAKEVILLE, MN 55044-8348
(507) 273-1084
Mailing address
12147 GANTRY LN, APPLE VALLEY, MN 55124-6297
(507) 273-1084
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
306150
MN
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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