Healthcare Provider Details

I. General information

NPI: 1235577404
Provider Name (Legal Business Name): AFTON MARIE KOBALL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AFTON MARIE SCHOUWEILER

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3258
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5812
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP5812
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: