Healthcare Provider Details

I. General information

NPI: 1649108564
Provider Name (Legal Business Name): KELIANA THOMPSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7835 3RD ST N STE 209
OAKDALE MN
55128-5445
US

IV. Provider business mailing address

7835 3RD ST N STE 209
OAKDALE MN
55128-5445
US

V. Phone/Fax

Practice location:
  • Phone: 651-327-0849
  • Fax:
Mailing address:
  • Phone: 651-327-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3314
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: