Healthcare Provider Details

I. General information

NPI: 1033446331
Provider Name (Legal Business Name): DENAE R KUENZEL PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 07/07/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 8TH ST NW STE A
ELK RIVER MN
55330-1581
US

IV. Provider business mailing address

21308 JOHN MILLESS DR STE 206
ROGERS MN
55374-4870
US

V. Phone/Fax

Practice location:
  • Phone: 763-441-3770
  • Fax: 763-441-9057
Mailing address:
  • Phone: 637-445-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2866
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP6407
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: