Provider Demographics
NPI:1609630821
Name:KERKULA, MANNUE LOUISE
Entity Type:Individual
Prefix:
First Name:MANNUE
Middle Name:LOUISE
Last Name:KERKULA
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 1:2021 E HENNEPIN AVE STE LL20
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2738
Mailing Address - Country:US
Mailing Address - Phone:612-259-7711
Mailing Address - Fax:612-345-4609
Practice Address - Street 1:7854 GARLAND LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2523
Practice Address - Country:US
Practice Address - Phone:401-545-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician