Individual
KRISTIN SOUTHWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18205 45TH AVE N STE C, PLYMOUTH, MN 55446-4594
(651) 478-4099
Mailing address
868 CARROLL AVE, SAINT PAUL, MN 55104-5411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2296
MN
Other
Enumeration date
12/16/2019
Last updated
01/06/2023
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