Provider Demographics
NPI:1265791503
Name:DYNAMIC CONNECTIONS, INC.
Entity type:Organization
Organization Name:DYNAMIC CONNECTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, RDI (C)CERT
Authorized Official - Phone:651-760-3109
Mailing Address - Street 1:2495 MAPLEWOOD DR STE 312
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1985
Mailing Address - Country:US
Mailing Address - Phone:651-760-3109
Mailing Address - Fax:651-967-9417
Practice Address - Street 1:2495 MAPLEWOOD DR STE 312
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1985
Practice Address - Country:US
Practice Address - Phone:651-760-3109
Practice Address - Fax:651-967-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty