Provider Demographics
NPI:1023864519
Name:KALINA, DALTON
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:KALINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 GLEN OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5609
Mailing Address - Country:US
Mailing Address - Phone:651-341-0492
Mailing Address - Fax:
Practice Address - Street 1:2042 WOODDALE DR STE 125
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4394
Practice Address - Country:US
Practice Address - Phone:651-689-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26910104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty