Provider Demographics
NPI:1811369366
Name:KESTNER, NAOMI RUTH (MA)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:RUTH
Last Name:KESTNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:R
Other - Last Name:METCALF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:401 16TH ST SE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-7974
Mailing Address - Country:US
Mailing Address - Phone:651-419-4314
Mailing Address - Fax:
Practice Address - Street 1:401 16TH ST SE STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7974
Practice Address - Country:US
Practice Address - Phone:651-419-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional