Individual
KASSONDRA LOROL GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
201 28TH AVE SW, WILLMAR, MN 56201-5241
(320) 214-8558
(320) 235-2733
Mailing address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/04/2020
Last updated
09/05/2024
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