Doctor Name: | MR. KENNETH NEIL MCDONNELL |
NPI Number: | 1700188216 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC, LPC |
License Number: | 301667 |
Business Practice Address: | 31065 Forrest Blvd Stacy, MN - 55079 |
Business Phone Number: | 6514087121 |
Business Fax Number: | 6514087131 |
Mailing Address: | Po Box 30, STACY |
State: | MN |
Postal Code: | 550790030 |
Phone Number: | 6514087121 |
Fax Number: | 6514087131 |
NPI Enumeration Date: | 12/03/2010 |
NPI Last Update Date: | 12/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 301667 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |