Doctor Name: | MS. MARY KAHLE |
NPI Number: | 1972677979 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., L.P. |
License Number: | LP 4021 |
Business Practice Address: | 1485 81st Ave Ne Spring Lake Park, MN - 554322111 |
Business Phone Number: | 7637803036 |
Business Fax Number: | 7637800784 |
Mailing Address: | 11709 Emery Village Dr N, CHAMPLIN |
State: | MN |
Postal Code: | 553162489 |
Phone Number: | 7637803036 |
Fax Number: | |
NPI Enumeration Date: | 11/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | LP 4021 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |