Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 103227 | MN |
NPI | 1821139049 |
---|---|
Provider Name | Mrs. Kristin Kay Gillard |
First Address | Rochester, MN 55906-5407 |
Second Address | Rochester, MN 55906-5407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 20/10/2021 |