Healthcare Provider Details

I. General information

NPI: 1992669378
Provider Name (Legal Business Name): MICHAELA CHRISTINE KERNER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHAELA CHRISTINE BRUDER

II. Dates (important events)

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

III. Provider practice location address

1306 MARSHALL ST
SAINT PETER MN
56082-4500
US

IV. Provider business mailing address

PO BOX 395
LAKE CRYSTAL MN
56055-0395
US

V. Phone/Fax

Practice location:
  • Phone: 507-931-8040
  • Fax: 507-931-8060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31433
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: