1134946759 NPI number — KESHA ALICIA ROYAL GUTE MSW, LGSW

Table of content: KESHA ALICIA ROYAL GUTE MSW, LGSW (NPI 1134946759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134946759 NPI number — KESHA ALICIA ROYAL GUTE MSW, LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROYAL GUTE
Provider First Name:
KESHA
Provider Middle Name:
ALICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LGSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROYAL GUTE
Provider Other First Name:
KESHA
Provider Other Middle Name:
ALICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134946759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3257 RUSSELL AVE N STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55412-2234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-401-2134
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEOPLE FIRST CLINIC PLLC
Provider Second Line Business Practice Location Address:
652 BIELENBERG DRIVE SUITE 202
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-401-2134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  30028 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)