MEDICARE: KENFIELD AND ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP1404	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5H791KE	OTHER	MN	BCBS
2	93957	OTHER	MN	HEALTHPARTNERS

General Provider Information

NPI Number	:	1598976698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENFIELD AND ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	2124 DUPONT AVE S
Second Line	:	SUITE 300
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2700
Country	:	US
Telephone Number	:	612-879-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 DUPONT AVE S
Second Line	:	SUITE 300
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2700
Country	:	US
Telephone Number	:	612-879-1010
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. JULIE A KENFIELD
Credential	:	PHD
Telephone Number	:	612-879-1010

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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