Individual
KYLE KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1150 MONTREAL AVE # 107, SAINT PAUL, MN 55116-2390
(651) 307-5148
Mailing address
1150 MONTREAL AVE # 107, SAINT PAUL, MN 55116-2390
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
MN
1041C0700X
Clinical Social Worker
Primary
22507
MN
Other
Enumeration date
09/15/2015
Last updated
03/09/2017
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