Healthcare Provider Details

I. General information

NPI: 1134832744
Provider Name (Legal Business Name): MAKAELA KUYKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 BIELENBERG DR STE 102-104
WOODBURY MN
55125-1700
US

IV. Provider business mailing address

3525 37TH AVE NE
MINNEAPOLIS MN
55421-4404
US

V. Phone/Fax

Practice location:
  • Phone: 612-445-8326
  • Fax:
Mailing address:
  • Phone: 612-644-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: