Healthcare Provider Details

I. General information

NPI: 1972448892
Provider Name (Legal Business Name): KIMBERLY ANN NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 PLEASANT VALLEY RD
CENTER CITY MN
55012-9640
US

IV. Provider business mailing address

1953A 75TH AVE
DRESSER WI
54009-4533
US

V. Phone/Fax

Practice location:
  • Phone: 651-213-4598
  • Fax: 651-213-4598
Mailing address:
  • Phone: 218-324-2751
  • Fax: 218-324-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12454-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2401
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: