Provider Demographics
NPI:1770868499
Name:KYLLANDER, ALISON JEAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:JEAN
Last Name:KYLLANDER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10165 119TH ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9419
Mailing Address - Country:US
Mailing Address - Phone:612-986-6777
Mailing Address - Fax:763-520-7562
Practice Address - Street 1:10165 119TH ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-9419
Practice Address - Country:US
Practice Address - Phone:612-986-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN154121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical