Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 226 | MN |
N | 103TC1900X | Counseling Psychologist |
NPI | 1114074028 |
---|---|
Provider Name | Ms. Melissa Ann Bollinger-Kinney |
First Address | Maple Grove, MN 55311-3938 |
Second Address | Plymouth, MN 55447-5120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 25/10/2018 |