Individual
JACQUELINE KELLY-FADDLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPCC
Contact information
Practice address
501 4TH ST S STE 201, PRINCETON, MN 55371-4754
(763) 498-1822
Mailing address
501 4TH ST S STE 201, PRINCETON, MN 55371-4754
(763) 482-1185
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
842
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881020527
—
MN
Enumeration date
09/25/2013
Last updated
05/02/2022
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