Healthcare Provider Details

I. General information

NPI: 1659235752
Provider Name (Legal Business Name): KYLE PARTRIDGE COLD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7766 HIGHWAY 65 NE
SPRING LAKE PARK MN
55432-2832
US

IV. Provider business mailing address

6519 APPALOOSA AVE N
FOREST LAKE MN
55025-9237
US

V. Phone/Fax

Practice location:
  • Phone: 612-618-3752
  • Fax:
Mailing address:
  • Phone: 612-618-3752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03031
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: