Provider Demographics
NPI:1922345677
Name:BURGETT, KERRI ANN (LP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ANN
Last Name:BURGETT
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:OCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:16201 90TH ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-7463
Practice Address - Country:US
Practice Address - Phone:763-746-9492
Practice Address - Fax:763-746-3685
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3172103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist