Individual
KAILA FORMANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
410 CHURCH ST SE, MINNEAPOLIS, MN 55455-0222
(612) 625-8400
Mailing address
410 CHURCH ST SE, MINNEAPOLIS, MN 55455-0222
(612) 625-8400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013137355
—
MN
Enumeration date
11/21/2022
Last updated
11/21/2022
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