Provider Demographics
NPI:1083133540
Name:KALLIMAN, STEPHANIE SUMMER
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUMMER
Last Name:KALLIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6381 OSGOOD AVE N BLDG C
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6118
Mailing Address - Country:US
Mailing Address - Phone:507-403-8190
Mailing Address - Fax:651-383-4544
Practice Address - Street 1:6381 OSGOOD AVE N BLDG C
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6118
Practice Address - Country:US
Practice Address - Phone:507-403-8190
Practice Address - Fax:651-383-4544
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty