Provider Demographics
NPI:1376177568
Name:SCHREIFELS, KELSEY MONICA
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MONICA
Last Name:SCHREIFELS
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 1:2925 DEAN PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-7700
Mailing Address - Country:US
Mailing Address - Phone:320-287-0433
Mailing Address - Fax:
Practice Address - Street 1:2925 DEAN PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-7700
Practice Address - Country:US
Practice Address - Phone:320-287-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
MNRBT-1854520106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician