Healthcare Provider Details

I. General information

NPI: 1619887825
Provider Name (Legal Business Name): JODY LEE KESSLER-GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NEVADA AVE
BENSON MN
56215-1023
US

IV. Provider business mailing address

1210 ELLA AVE NW
WILLMAR MN
56201-2442
US

V. Phone/Fax

Practice location:
  • Phone: 320-842-2717
  • Fax:
Mailing address:
  • Phone: 320-905-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number101220
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: