Provider Demographics
NPI:1629052394
Name:KELLOGG, MARGARET B (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:B
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1374 EDGCUMBE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1726
Mailing Address - Country:US
Mailing Address - Phone:612-638-7233
Mailing Address - Fax:651-699-4105
Practice Address - Street 1:2046 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1650
Practice Address - Country:US
Practice Address - Phone:612-638-7233
Practice Address - Fax:612-699-4105
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3652103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling