Healthcare Provider Details

I. General information

NPI: 1265948186
Provider Name (Legal Business Name): KIMBERLY JEAN DEJNO LADC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3257 19TH ST NW STE 4
ROCHESTER MN
55901-6797
US

IV. Provider business mailing address

3257 19TH ST NW STE 4
ROCHESTER MN
55901-6797
US

V. Phone/Fax

Practice location:
  • Phone: 651-955-4633
  • Fax: 651-440-9827
Mailing address:
  • Phone: 651-955-4633
  • Fax: 651-440-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number303922
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3329
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: