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General NPI Number Information
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NPI Number | 1053809996
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Entity Type | Individual
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Provider Name | MALINDA MAY KRANZ-MARBLE LADC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 13637 60TH ST SW
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City | COKATO
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State | MN
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Zip | 55321-4210
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Country | US
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Telephone | 507-327-9890
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Fax |
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Provider Business Mailing Address
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Address Line | 56341 134TH ST
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City | MAPLETON
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State | MN
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Zip | 56065-4509
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Country | US
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Telephone | 507-327-9890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1084343
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License Number State | MN
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