MEDICARE: MS. MARGARET B KELLOGG M.A., L.P.

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	103TC1900X	Counseling Psychologist	3652	MN

General Provider Information

NPI Number	:	1629052394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGARET B KELLOGG M.A., L.P.

Provider Business Mailing Address
First Line	:	1374 EDGCUMBE RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1726
Country	:	US
Telephone Number	:	612-638-7233
Fax Number	:	651-699-4105

Provider Business Practice Location Address
First Line	:	2046 SAINT CLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1650
Country	:	US
Telephone Number	:	612-638-7233
Fax Number	:	612-699-4105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/03/2014

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