Individual
DR. KENT DAVID SMALLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
15251 PLEASANT VALLEY RD # CO7, CENTER CITY, MN 55012-9640
(651) 213-4169
(651) 213-4515
Mailing address
15251 PLEASANT VALLEY RD # CO7, PO BOX 11, CENTER CITY, MN 55012-9640
(651) 213-4169
(651) 213-4515
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5358
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9058
—
IL
Enumeration date
08/29/2007
Last updated
03/11/2021
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