Healthcare Provider Details

I. General information

NPI: 1699689075
Provider Name (Legal Business Name): KAITLYN PERRONE LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 S MINNESOTA ST
CROOKSTON MN
56716-1800
US

IV. Provider business mailing address

6044 JAMES AVE S
MINNEAPOLIS MN
55419-2141
US

V. Phone/Fax

Practice location:
  • Phone: 218-275-5418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306266
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: