Provider Demographics
NPI:1821797895
Name:KJELLAND, KAITA
Entity Type:Individual
Prefix:
First Name:KAITA
Middle Name:
Last Name:KJELLAND
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 1:1401 8TH ST S STE 3
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3658
Mailing Address - Country:US
Mailing Address - Phone:170-135-6763
Mailing Address - Fax:
Practice Address - Street 1:1401 8TH ST S STE 3
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3658
Practice Address - Country:US
Practice Address - Phone:170-135-6763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist