Healthcare Provider Details

I. General information

NPI: 1912099102
Provider Name (Legal Business Name): RACHAEL L KRAHN LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 NICOLLET AVE
MINNEAPOLIS MN
55404-3461
US

IV. Provider business mailing address

5104 PORTLAND AVE
MINNEAPOLIS MN
55417-1748
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-1454
  • Fax: 612-871-1505
Mailing address:
  • Phone: 612-871-1454
  • Fax: 612-871-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4357
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: