Provider Demographics
NPI:1093351454
Name:KOELLNER, CHRISTINE (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KOELLNER
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 HARBOR DR SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5925
Mailing Address - Country:US
Mailing Address - Phone:612-310-3328
Mailing Address - Fax:
Practice Address - Street 1:3109 HARBOR DR SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5925
Practice Address - Country:US
Practice Address - Phone:612-310-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1046170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS