Individual
KELLY VOURLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
10505 WAYZATA BLVD STE 101, MINNETONKA, MN 55305-1507
(952) 484-2020
(952) 492-7885
Mailing address
803 LODGE DR, JORDAN, MN 55352-1453
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
15164
MN
Other
Enumeration date
03/11/2015
Last updated
07/22/2019
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