Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LPC00507 | MN |
Y | 103T00000X | Psychologist | LPC00507 | MN |
NPI | 1003051798 |
---|---|
Provider Name | Jennifer L Kerkvliet |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2008 |
Last Update Date | 09/12/2008 |