Basic Information
| Provider Information | |||||||||
| NPI: | 1356574610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATHMAN | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | JEAN BENOLKIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | GENETIC COUNSELOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE STREET SE | ||||||||
| Address2: | MMC 485 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122730688 | ||||||||
| FaxNumber: | 6122730886 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 CENTRACARE CIRCLE #2300 | ||||||||
| Address2: | CENTRACARE CLINIC - WOMEN'S & CHILDRENS | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206543655 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2009 | ||||||||
| LastUpdateDate: | 12/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.