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General NPI Number Information
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NPI Number | 1609538628
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Entity Type | Individual
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Provider Name | MELISSA KANE
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Gender | Female
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 7601 WAYZATA BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-1623
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Country | US
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Telephone | 612-286-0857
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Fax |
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Provider Business Mailing Address
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Address Line | 8927 SYNDICATE AVE APT 329
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City | CIRCLE PINES
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State | MN
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Zip | 55014-3783
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Country | US
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Telephone | 612-669-3881
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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