1942306964 NPI number — BRENDA L KITTILSON MS LPC

Table of content: BRENDA L KITTILSON MS LPC (NPI 1942306964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942306964 NPI number — BRENDA L KITTILSON MS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITTILSON
Provider First Name:
BRENDA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942306964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2497 7TH AVE E
Provider Second Line Business Mailing Address:
SUITE 101 BHSI LLC
Provider Business Mailing Address City Name:
NORTH ST PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55109-2496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-769-6437
Provider Business Mailing Address Fax Number:
651-769-6426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7616 CURRELL BLVD
Provider Second Line Business Practice Location Address:
SUITE 290 BHSI LLC
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125-8204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-769-6550
Provider Business Practice Location Address Fax Number:
651-769-6599
Provider Enumeration Date:
09/16/2006

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: 101YM0800X , with the licence number:  00159 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 13033 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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