Provider Demographics
NPI:1356574610
Name:ATHMAN, KELLY JEAN BENOLKIN (GENETIC COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JEAN BENOLKIN
Last Name:ATHMAN
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Gender:F
Credentials:GENETIC COUNSELOR
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Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:MMC 485
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-0688
Mailing Address - Fax:612-273-0886
Practice Address - Street 1:1900 CENTRACARE CIRCLE #2300
Practice Address - Street 2:CENTRACARE CLINIC - WOMEN'S & CHILDRENS
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2012-12-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS