Healthcare Provider Details

I. General information

NPI: 1447470687
Provider Name (Legal Business Name): DAVID K KRONMILLER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1678 SELBY AVE.
ST PAUL MN
55104
US

IV. Provider business mailing address

1678 SELBY AVE.
ST PAUL MN
55104
US

V. Phone/Fax

Practice location:
  • Phone: 651-647-5722
  • Fax: 651-647-5723
Mailing address:
  • Phone: 651-647-5722
  • Fax: 651-647-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP0241
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberLP0241
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberLP0241
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: