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General NPI Number Information
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NPI Number | 1174472328
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Entity Type | Individual
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Provider Name | KELLY ANN VILLA
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Gender | Female
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 114 MINNESOTA ST. SANDSTONE, MN 55072
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City | SANDSTONE
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State | MN
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Zip | 55072-5028
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Country | US
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Telephone | 218-380-2551
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Fax | 218-520-3913
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Provider Business Mailing Address
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Address Line | 721 HIGHWAY 23 N
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City | SANDSTONE
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State | MN
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Zip | 55072-5028
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Country | US
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Telephone | 218-481-5546
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Fax | 218-520-3913
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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 | 303304
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License Number State | MN
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