Healthcare Provider Details

I. General information

NPI: 1366853442
Provider Name (Legal Business Name): KARIE KAY KROON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 LONDON RD STE 204
DULUTH MN
55805-2422
US

IV. Provider business mailing address

1420 LONDON RD STE 204
DULUTH MN
55805-2422
US

V. Phone/Fax

Practice location:
  • Phone: 218-393-5407
  • Fax: 218-461-3666
Mailing address:
  • Phone: 218-393-5407
  • Fax: 218-461-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19849
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: