Healthcare Provider Details

I. General information

NPI: 1770350845
Provider Name (Legal Business Name): KAYLA MARIE DJONNE MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 BERKSHIRE LN N STE 250
PLYMOUTH MN
55446-3813
US

IV. Provider business mailing address

4100 BERKSHIRE LN N STE 250
PLYMOUTH MN
55446-3813
US

V. Phone/Fax

Practice location:
  • Phone: 612-223-8898
  • Fax:
Mailing address:
  • Phone: 612-223-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31882
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: