Provider Demographics
NPI:1336842657
Name:DUESTERHAUS, KENADY EMMA
Entity Type:Individual
Prefix:
First Name:KENADY
Middle Name:EMMA
Last Name:DUESTERHAUS
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 1:2409 LYNDALE AVE S UNIT 201
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-3357
Mailing Address - Country:US
Mailing Address - Phone:920-540-9459
Mailing Address - Fax:
Practice Address - Street 1:434 HAYWARD AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5379
Practice Address - Country:US
Practice Address - Phone:651-739-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician