Individual
MR. KRIS CARL WICKLUND I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT, LADC
Contact information
Practice address
11010 PRAIRIE LAKES DR, SUITE 350, EDEN PRAIRIE, MN 55344-3884
(952) 746-2522
Mailing address
1900 SILVER LAKE RD NW, SUITE 110, NEW BRIGHTON, MN 55112-1786
(651) 379-1718
(651) 379-1738
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303844
MN
106H00000X
Marriage & Family Therapist
Primary
2896
MN
Other
Enumeration date
06/21/2014
Last updated
07/10/2014
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