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Individual

MR. KENNETH BRUCE SUTHERLAND

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
L.P.

Contact information

Practice address
7800 METRO PKWY, SUITE 300, BLOOMINGTON, MN 55425-1514
(952) 854-6066
(952) 854-6766
Mailing address
7800 METRO PKWY, SUITE 300, BLOOMINGTON, MN 55425-1514
(952) 854-6066
(952) 854-6766

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1175
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
101776
UCARE
MN
01
3033056
HEALTH PARTNERS
MN
01
553869
VALUE OPTIONS
MN
01
6237451
MEDICA
MN
01
64G51SU
BLUE CROSS BLUE SHIELD MN
MN
01
990990306005
PREFERRED ONE
MN
Enumeration date
03/14/2007
Last updated
07/09/2007
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