Healthcare Provider Details

I. General information

NPI: 1184391187
Provider Name (Legal Business Name): KELSEY STOLTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NORTHWOODS DR
ARDEN HILLS MN
55112-6966
US

IV. Provider business mailing address

1619 DAYTON AVE STE 325
SAINT PAUL MN
55104-6495
US

V. Phone/Fax

Practice location:
  • Phone: 651-787-9600
  • Fax:
Mailing address:
  • Phone: 651-314-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2959
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: