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General NPI Number Information
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NPI Number | 1649902685
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Entity Type | Individual
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Provider Name | AARON JOSHUA KENNELL LGSW
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Gender | Male
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 1303 S FRONTAGE RD STE 221
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City | HASTINGS
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State | MN
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Zip | 55033-2688
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Country | US
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Telephone | 224-424-4194
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Fax |
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Provider Business Mailing Address
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Address Line | 4340 BRYANT AVE S APT 3
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City | MINNEAPOLIS
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State | MN
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Zip | 55409-1775
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Country | US
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Telephone | 321-402-3180
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 30953
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License Number State | MN
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