Individual
KERRY LYNN VAN DUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD LP
Contact information
Practice address
324 W SUPERIOR ST, SUITE 400, DULUTH, MN 55802
(218) 740-3026
(218) 740-3030
Mailing address
324 W SUPERIOR ST, SUITE 400, DULUTH, MN 55802
(218) 740-3026
(218) 740-3030
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4115
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174M6N0
BCBS
MN
01
—
174M7VA
BCBS
MN
05
—
705222700
—
MN
Enumeration date
03/14/2007
Last updated
12/30/2021
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