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General NPI Number Information
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NPI Number | 1609008010
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Entity Type | Organization
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Legal Business Name | KATHLYN NELSON PHD LLC
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 7616 CURRELL BLVD STE. 280
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City | WOODBURY
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State | MN
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Zip | 55125-2290
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Country | US
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Telephone | 651-341-9667
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Fax | 651-735-7527
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Provider Business Mailing Address
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Address Line | 2546 DOROTHY AVE
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4911
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Country | US
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Telephone | 651-341-9667
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. KATHLYN ELVERA NELSON
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Credential | PHD
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Telephone | 651-341-9667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LP 3967
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License Number State | MN
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