Provider Demographics
NPI:1184722845
Name:KALLIO, JOELLE LYNNE (PSYD, LP)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:LYNNE
Last Name:KALLIO
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 SNELLING AVE S STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1594
Mailing Address - Country:US
Mailing Address - Phone:651-917-5040
Mailing Address - Fax:651-917-3018
Practice Address - Street 1:627 SNELLING AVE S STE 210
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1594
Practice Address - Country:US
Practice Address - Phone:651-917-5040
Practice Address - Fax:651-917-3018
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4463103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN215937600Medicaid
MN680002462Medicare PIN