Healthcare Provider Details

I. General information

NPI: 1265791503
Provider Name (Legal Business Name): DYNAMIC CONNECTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 08/24/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 MAPLEWOOD DR STE 312
MAPLEWOOD MN
55109-1985
US

IV. Provider business mailing address

2495 MAPLEWOOD DR STE 312
MAPLEWOOD MN
55109-1985
US

V. Phone/Fax

Practice location:
  • Phone: 651-760-3109
  • Fax: 651-967-9417
Mailing address:
  • Phone: 651-760-3109
  • Fax: 651-967-9417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTI KAY WORRELL
Title or Position: EXECUTIVE DIRECTOR
Credential: OTR/L, RDI (C)CERT
Phone: 651-760-3109