Individual
DR. JASON EDWARD KISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3915 GOLDEN VALLEY RD, MINNEAPOLIS, MN 55422-4249
(612) 262-3464
Mailing address
3915 GOLDEN VALLEY RD, MINNEAPOLIS, MN 55422-4249
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
6301017201
MI
103G00000X
Clinical Neuropsychologist
Primary
LP6782
MN
103TC0700X
Clinical Psychologist
6301017201
MI
103TC0700X
Clinical Psychologist
LP6782
MN
Other
Enumeration date
06/05/2019
Last updated
06/10/2022
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