Doctor Name: | MR. KYLE GREGORY CLOUTIER |
NPI Number: | 1871646216 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LICSW |
License Number: | 13976 |
Business Practice Address: | 1120 Centre Pointe Dr Ste 100 #100 Mendota Heights, MN - 551201275 |
Business Phone Number: | 9523348278 |
Business Fax Number: | 9528914258 |
Mailing Address: | Po Box 240125, APPLE VALLEY |
State: | MN |
Postal Code: | 551240125 |
Phone Number: | 9523348278 |
Fax Number: | 9528914258 |
NPI Enumeration Date: | 01/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 13976 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |