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NPI Code Detail

MEDICARE: MS. JOANNE AGNES KANE LP

MEDICARE: MS. JOANNE AGNES KANE LP
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
1103TC1900XCounseling PsychologistLP#3876MN

General Provider Information

NPI Number : 1861477234
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JOANNE AGNES KANE LP
Provider Business Mailing Address
First Line : 18401 377TH ST
Second Line :
City : AVON
State : MN
Zip : 56310-9502
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Provider Business Practice Location Address
First Line : 600 25TH AVE S
Second Line : SUITE 109 ROOSEVELT OFFICE PARK
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 07/08/2007

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Directions to “ MS. JOANNE AGNES KANE LP” Practice Location

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