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Organization

K.I.D.S.&FAMILY THERAPY,LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DEBORAH K OTTO (ADMINISTRATOR)
(763) 323-8050
Entity
Organization

Contact information

Practice address
11157 ZEALAND AVE N, CHAMPLIN, MN 55316-3595
(763) 710-9949
Mailing address
11157 ZEALAND AVE N, CHAMPLIN, MN 55316-3595
(763) 710-9949

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5822
MN

Other

Enumeration date
01/14/2015
Last updated
01/14/2015
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