Provider Demographics
NPI:1184192551
Name:KIRKBRIDE, SONJA (BS, LADC)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:KIRKBRIDE
Suffix:
Gender:F
Credentials:BS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MN
Mailing Address - Zip Code:55011-0358
Mailing Address - Country:US
Mailing Address - Phone:612-384-2689
Mailing Address - Fax:
Practice Address - Street 1:6058 HIGHWAY 10 NW
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4530
Practice Address - Country:US
Practice Address - Phone:763-421-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)