Healthcare Provider Details

I. General information

NPI: 1275880809
Provider Name (Legal Business Name): KELLEY ANN SEHMAN PSY.D., LP, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 PARK AVE
MINNEAPOLIS MN
55407-1006
US

IV. Provider business mailing address

6998 TIMBER RIDGE TRL S
COTTAGE GROVE MN
55016-4467
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-7443
  • Fax:
Mailing address:
  • Phone: 651-238-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP6284
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302933
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: