Healthcare Provider Details

I. General information

NPI: 1588689384
Provider Name (Legal Business Name): JOSHUA M KENT LICSW MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7616 CURRELL BLVD SUITE 275
WOODBURY MN
55125
US

IV. Provider business mailing address

9007 KAGAN AVE NE
MONTICELLO MN
55362
US

V. Phone/Fax

Practice location:
  • Phone: 612-710-3671
  • Fax:
Mailing address:
  • Phone: 612-710-3671
  • Fax: 763-295-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15118
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: