Individual
KAITLEN GULLICKSRUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC/R
Contact information
Practice address
1151 TRANSIT AVE, ROSEVILLE, MN 55113-3233
(715) 379-0408
Mailing address
1151 TRANSIT AVE, ROSEVILLE, MN 55113-3233
(715) 379-0408
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2325
MN
Other
Enumeration date
06/07/2016
Last updated
06/07/2016
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